Search PubMed⌕ Search

Biomedical subjects

E Bouza

Publications and source records attributed to E Bouza.

At least 73 records · Page 4Linked to original sources
PubMed2001

In vitro activity of new quinolones against Clostridium difficile.

We evaluated the in vitro activities of ofloxacin, levofloxacin, grepafloxacin, trovafloxacin and ciprofloxacin against Clostridium difficile. The MIC(90) was 128 mg/L for ofloxacin and levofloxacin, 64 mg/L for ciprofloxacin, 16 mg/L for grepafloxacin and 8 mg/L for trovafloxacin. Thirty per cent of isolates were resistant to trovafloxacin, and rates of resistance to ofloxacin, levofloxacin, grepafloxacin and ciprofloxacin were considerably higher. None of the antimicrobials studied would be a reliable therapeutic option against C. difficile. Whether some of the new fluoroquinolones can induce C. difficile-associated diarrhoea remains to be answered.

4-Quinolones↗
PubMed2001

Comparative in vitro activity of the new quinolone gemifloxacin (SB-265805) with other fluoroquinolones against respiratory tract pathogens.

The in vitro activity of gemifloxacin (SB-265805) was compared with that of other fluoroquinolones against 302 clinical isolates of Streptococcus pneumoniae, 300 clinical isolates of Haemophilus influenzae and 28 clinical isolates of Moraxella catarrhalis, including multiply resistant strains. Gemifloxacin at 0.12 mg/L inhibited all microorganisms tested. MIC(90) values of gemifloxacin, trovafloxacin, grepafloxacin and levofloxacin against all (630) isolates tested were 0.03, 0.12, 0.12 and 1 mg/L, respectively. MIC(90) values of the same fluoroquinolones against S. pneumoniae were 0.06, 0.25, 0.12 and 1 mg/L, respectively.

Anti-Infective Agents↗
PubMed2001

Cefepime versus cefotaxime for empirical treatment of bacterial pneumonia in HIV-infected patients: an open, randomized trial.

An open, randomized, multicentre clinical trial was conducted to compare the efficacy and safety of cefepime 2 g iv bd (2 g tds daily in cases of Pseudomonas aeruginosa pneumonia) with cefotaxime 2 g iv tds, in the empirical treatment of bacterial pneumonia in HIV-infected patients. The primary end-point was effectiveness after 3-5 days of treatment, taking success to be when the study drug was continued during this period of time. Clinical and bacteriological responses at end of treatment (EOT) were also evaluated. Analyses of the intention-to-treat population (n = 160) and the as-per-protocol groups (n = 150) were carried out. Treatment groups were comparable with regard to sex, age, HIV status and degree of severity of pneumonia. The primary end-point for cefepime was considered successful for the intention-to-treat and as-per-protocol groups in 85.7% and 93.5% of cases, respectively, and for cefotaxime, in 77.6% and 80.8% of cases, respectively (P = 0.22 and P = 0.02). In the as-per-protocol group, cefotaxime treatment was independently related to failure at the primary end-point. A satisfactory clinical response in the intention-to-treat population was observed in 83.3% of cefepime and 82.9% of cefotaxime patients. Bacteriological cure was obtained in 100% of evaluable cefepime and 93.4% of evaluable cefotaxime patients at EOT. Safety of the study drugs was comparable in both treatment groups. Cefepime 2 g iv bd was at least as effective and as well tolerated as cefotaxime 2 g iv tds in the treatment of bacterial pneumonia in HIV-infected patients.

Adult↗
PubMed2001

Visceral leishmaniasis in human immunodeficiency virus (HIV)-infected and non-HIV-infected patients. A comparative study.

Visceral leishmaniasis is an endemic infection in Mediterranean countries, where it has become a frequent complication of acquired immunodeficiency syndrome (AIDS). The incidence of visceral leishmaniasis is increasing in Spain due to human immunodeficiency virus (HIV)-related cases, but some aspects of its epidemiology, clinical features, and management remain unknown. In addition, no comparative clinical studies about the disease in HIV-infected and non-HIV-infected patients have been reported. During a 24-year period, 120 cases of visceral leishmaniasis were diagnosed at our institution and 80 (66%) were associated with HIV infection. The mean age at diagnosis was higher in HIV-infected that in non-HIV-infected patients (33.2 versus 23.2 yr; p = 0.002), but the male/female ratio was similar in both groups. The main risk factor for HIV infection was intravenous drug abuse (78.7%). The clinical presentation of leishmaniasis was similar in both groups, but HIV-infected patients had a lower frequency of splenomegaly than HIV-negative individuals (80.8% versus 97.4%; p = 0.02). HIV-infected patients had a greater frequency and degree of leukopenia, lymphocytopenia, and thrombocytopenia. Most of them were profoundly immunosuppressed (mean CD4+ lymphocyte count, 90 cells/mm3) at the time of diagnosis of leishmaniasis, and 53.7% had AIDS. The sensitivity of serologic studies for Leishmania was significantly lower in HIV-infected than in non-HIV-infected patients (50% versus 80%; p < 0.001), but the diagnostic yield of bone marrow aspirate (67.1% versus 79.4%) and bone marrow culture (62.9% versus 66.6%) was similar in both groups. After initial treatment, the response rate was significantly lower in HIV-infected than in non-HIV-infected individuals (54.8% versus 89.7%; p = 0.001). The relapse rate was 46.2% and 7.5%, respectively (p < 0.001). Secondary prophylaxis with antimonial compounds or amphotericin B seems to be useful in preventing relapses in HIV-infected patients. The mortality rate was higher (53.7% versus 7.5%; p < 0.001) and the median survival time shorter (25 versus > 160 mo; p < 0.001) in AIDS patients than in HIV-negative individuals. Although leishmaniasis could contribute to death in a significant number of HIV-infected patients, it was the main cause of death in only a few of them. The CD4+ lymphocyte count and the use of highly active antiretroviral therapy and secondary prophylaxis for leishmaniasis were the most significant prognostic factors for survival in AIDS patients. Visceral leishmaniasis behaves as an opportunistic infection in HIV-infected individuals and should be considered as an AIDS-defining disease.

AIDS-Related Opportunistic Infections↗
PubMed2001

Environmental surveillance and other control measures in the prevention of nosocomial fungal infections.

The steady world-wide increase in the number of severely immunocompromised patients in most hospitals has made the control and prevention of nosocomial systemic fungal infections a critical quality-of-care standard. Early diagnosis and antifungal prophylaxis of these infections are complicated, so avoiding the acquisition of the pathogen in the case of Aspergillus and minimizing the predisposing risk factors in the case of Candida are more effective approaches. The maintenance of good air quality in critical areas in hospitals is mandatory to reduce the incidence of invasive aspergillosis. We review the currently available Center for Disease Control recommendations and report our own experiences in the field. The indications and problems of fungal environmental and patient surveillance are also discussed.

Air Microbiology↗
PubMed2001

Antimicrobial susceptibilities of 1,730 Haemophilus influenzae respiratory tract isolates in Spain in 1998-1999.

A beta-lactamase prevalence of 23% was found among 1,730 Haemophilus influenzae isolates. Ampicillin susceptibility was 70%, and 12% of beta-lactamase-negative strains presented diminished susceptibility to ampicillin (BLNAR phenotype). Susceptibility of 90% was found for cefaclor and clarithromycin, whereas it was nearly 100% for cefotaxime, cefixime, azithromycin, and cefuroxime. Ciprofloxacin-resistant (0.1%) and beta-lactamase-positive amoxicillin/clavulanate-resistant (BLPACR) phenotypes (0.1%) are anecdotal so far.

Anti-Bacterial Agents↗
PubMed2001

Antimicrobial susceptibilities of 1,684 Streptococcus pneumoniae and 2,039 Streptococcus pyogenes isolates and their ecological relationships: results of a 1-year (1998-1999) multicenter surveillance study in Spain.

A nationwide multicenter susceptibility surveillance study which included 1,684 Streptococcus pneumoniae and 2,039 S. pyogenes isolates was carried out over 1 year in order to assess the current resistance patterns for the two most important gram-positive microorganisms responsible for community-acquired infections in Spain. Susceptibility testing was done by a broth microdilution method according to National Committee for Clinical Laboratory Standards M100-S10 interpretative criteria. For S. pneumoniae, the prevalences of highly resistant strains were 5% for amoxicillin and amoxicillin-clavulanic acid; 7% for cefotaxime; 22% for penicillin; 31% for cefuroxime; 35% for erythromycin, clarithromycin, and azithromycin; and 42% for cefaclor. For S. pyogenes, the prevalence of erythromycin resistance was 20%. Efflux was encountered in 90% of S. pyogenes and 5% of S. pneumoniae isolates that exhibited erythromycin resistance. Erythromycin resistance was associated with clarithromycin and azithromycin in both species, regardless of phenotype. Despite the different nature of the mechanisms of resistance, a positive correlation (r = 0.612) between the two species in the prevalence of erythromycin resistance was found in site-by-site comparisons, suggesting some kind of link with antibiotic consumption. Regarding ciprofloxacin, the MIC was >or=4 microg/ml for 7% of S. pneumoniae and 3.5% of S. pyogenes isolates. Ciprofloxacin resistance (MIC, >or=4 microg/ml) was significantly (P < 0.05) associated with macrolide resistance in both S. pyogenes and S. pneumoniae and with penicillin nonsusceptibility in S. pneumoniae.

Drug Prescriptions↗
PubMed2001

Catheter-related infections: diagnosis and intravascular treatment.

The diagnosis of catheter-related infections relies on the presence of clinical manifestations of infection and the evidence of colonization of the catheter tip by bacteria, mycobacteria or fungi. The reference method to confirm the latter requires the withdrawal of the catheter for culturing, which frequently turns out to be inconvenient, unnecessary and costly. New methods try to avoid these inconveniences and to assess the presence of tip colonization without withdrawal. One of these methods uses quantitative blood cultures with a jump (> or = 5) in colony counts between blood obtained from the catheter lumen and simultaneously from a peripheral vein. It has a high sensitivity (>80%) and specificity (94%-100%) but is cumbersome and requires both an easy backflow of blood in the catheter and the existence of bacteremia. Cytocentrifugation and acridine orange staining of blood withdrawn from an infected catheter lumen has a sensitivity and a specificity of over 90% for the diagnosis of tip colonization. "Superficial cultures" consist in the semiquantitative culture of the hub, of the skin surrounding the catheter entrance and of the first (1 cm) subcutaneous portion of the catheter after swabbing. Sensitivity of this method is >90% and specificity is >80%, and positive and negative predictive values for catheters (considering together those with and without clinical data of infection) are 66% and 97%, respectively. Endoluminal brushing has turned out to be an impractical and unreliable procedure, at least in our experience. New methods based on the speed of bacterial growth to detectable levels of microorganisms in conventional blood cultures are a new and interesting way of assessing catheter-related infections. Besides, as use of antimicrobial-coated catheters becomes more prevalent, the existing definitions of catheter colonization and catheter-related infection may need to be modified, because such coatings may lead to false-negative culture results. Many catheter infections, diagnosed without catheter withdrawal, can be handled nowadays with the so-called "antibiotic lock-in technique", which consists in locking the infected catheter lumen with a solution containing antibiotics. A high proportion of infected catheters, mainly those with coagulase-negative staphylococci, can be maintained in place and sterilized with this technique, including catheters in patients with therapeutic failure after receiving conventional intravenous antibiotic therapy. New diagnostic and therapeutic techniques may avoid the unnecessary withdrawal of thousands of efficient, difficult to replace and expensive intravascular lines.

Anti-Bacterial Agents↗
PubMed2000

Monotherapy versus combination therapy for bacterial infections.

The authors discuss the latest findings regarding the use of one or more antimicrobial drugs for a variety of infections. They offer suggestions for treatment based on a host of considerations, including the synergy and antagonism of specific drugs, type of infection, potential toxicities, and cost.

Anti-Bacterial Agents↗
PubMed2000

Feculent meningitis: polymicrobial meningitis in colorectal surgery.

Polymicrobial anaerobic meningitis is a rare event secondary to a contiguous infection in the head or neck. Anaerobic meningitis due to a meningo-intestinal fistula is a rare event with only two cases reported in the literature. We describe a new case of adult polymicrobial anaerobic meningitis after colorectal surgery and radiotherapy and review the previous two cases.

Aged↗
PubMed2000

Utility of the BACTEC Myco/F lytic medium for the detection of mycobacteria in blood.

This study aims to evaluate the performance of a new vial (Myco/F Lytic) for the detection of mycobacteria from blood specimens. This vial is monitored in the BACTEC 9000 blood culture system. We compared it with the traditional method routinely used in our laboratory, which is a lysis-centrifugation based procedure. Of 275 samples tested in parallel by both methods, 23 from 20 patients grew mycobacteria (18 Mycobacterium avium complex, 4 M. tuberculosis and 1 M. simiae); 11 isolates were recovered using both systems, 12 were isolated with the Myco/F Lytic medium only, and none were isolated using the traditional method only (p < 0.05). Blood was the diagnostic sample for 12 patients with the Myco/F Lytic system and only 7 with the traditional system. The mean time to detection of mycobacteria with Myco/F Lytic medium was 17 days, whereas it was 44 days with the traditional method (p < 0.001). Identification by DNA probes was performed directly from the Myco/F Lytic bottle. Myco/F Lytic is a rapid, simple, safe and highly reliable diagnostic method for the detection of mycobacteria in blood.

Bacteremia↗
PubMed2000

Criteria used when initiating antifungal therapy against Candida spp. in the intensive care unit.

Invasive candidiasis is a life threatening complication for intensive care unit (ICU) patients. The infection is difficult to recognise so that treatment may be delayed or even not given. Risk factors for candidiasis include the use of antimicrobial agents, central intravascular devices (mainly Hickmann catheters), recurrent gastrointestinal perforations, surgery for acute pancreatitis or splenectomy and renal dysfunction or haemodialysis. Therapy against Candida spp is recommended in ICU patients with endophthalmitis or chorioretinitis possibly caused by Candida spp., in symptomatic patients with risk factors for invasive candidiasis especially if two or more anatomical sites are colonised and for asymptomatic high-risk surgical patients (with recent abdominal surgery or recurrent gastrointestinal perforations or anastomotic leakages). The isolation of Candida from any site poses an increased risk but there are a few microbiological data that might help to establish the predictive value of a particular isolate. These include the site of isolation, the number of culture positive, noncontigous sites, the density of colonisation and the species isolated. Antifungals should be started when Candida spp. are recovered from blood cultures or from usually sterile body fluids, abscesses or wounds in burns patients. They should also be considered in patients with a colonisation index >0.5 or a corrected colonization index >0.4 or when the isolate is identified as Candida tropicalis.

Antifungal Agents↗
PubMed2000

Lung nodular lesions in heart transplant recipients.

To describe the characteristics and etiology of lung nodules after heart transplantation (HT). During a 6-year period 147 patients received HT and 130 survived more than 1 week. Nodular lesions were demonstrated after HT in 13 patients (10%). Median age was 53 years, and all patients were male. Nodules were detected 23 to 158 days after HT (median, 66 days). An etiologic diagnosis was made in all but 1 case: Aspergillus (5), Nocardia-Rhodococcus (4), and cytomegalovirus (CMV) (3). Previous severe infection was present in 50% of the patients and rejection in 33% (75% with nocardiosis). Initially all patients with Nocardia but only 1 patient with aspergillosis were asymptomatic. The most common symptoms were fever (67%) and cough (50%). Central nervous system (CNS) involvement appeared in only one Aspergillus-infected patient. An average of 1.8 diagnostic procedures per patient were performed. Median time to establish a diagnosis was 8 days (0 to 24). Median hospital stay was 36 days and reached 60 in patients with Aspergillus. No patient died, although aspergillosis, which must be suspected in the presence of dyspnea, pleuritic pain, and CNS symptoms, caused the highest morbidity. Overall diagnostic yield was 60% for transtracheal aspiration, 70% for bronchoalveolar lavage, and 75% for transthoracic aspiration. Ten percent of HT patients developed lung nodules that were mainly caused by Aspergillus, Nocardia, and CMV. The time of appearance and some clinical manifestations may suggest the etiology and may help in the empirical treatment.

Adult↗
PubMed2000

Use and misuse of antimicrobial agents in a general hospital in the AIDS era.

A prevalence study was carried out to ascertain the pattern of antimicrobial use, costs and relevance in a general hospital during the AIDS era. All patients receiving antimicrobials were studied. Antimicrobials were divided into antibacterial drugs and others and the costs evaluated in US dollars. Of 1526 patients surveyed, 455 (29.8%) were receiving 664 courses of antimicrobials: 109 (7.2%) as prophylaxis and 346 (22.6%) as treatment. Fifteen percent of courses involved non-antibacterial drugs. In 188 patients (40.9% of those treated) treatment was inadequate, usually because of incorrect drug choice. Daily cost of antimicrobials was $14953. AIDS accounted for 3% of all patients, 9% of those receiving antimicrobials, 19.7% of antimicrobial usage and 9.6% of the antimicrobial expenditure. Misuse occurred in 43% of non-HIV patients and 17% of those with HIV. Thus, despite a disproportionate contribution of patients with AIDS, adequacy of use of antimicrobials was better in this population.

AIDS-Related Opportunistic Infections↗
PubMed2000

Teicoplanin in the treatment of serious infection.

The merits and dosing regimens for teicoplanin in the treatment of endocarditis, bacteremia, bone and joint infections, pediatric use, non in-patient use and in the ICU are discussed. Teicoplanin has several advantages over vancomycin in the treatment of serious infections: long half-life, lower nephrotoxicity, and lack of requirement for serum assays. The recommended regimen for teicoplanin is three loading doses of 6 mg/kg (400 mg) q12h, then 6 mg/kg (400 mg) q24h. There is no significant difference in efficacy between teicoplanin and vancomycin when at least 6 mg/kg teicoplanin is used or, in the case of staphylococcal endocarditis, it is given in combination with another antimicrobial. Teicoplanin is effective and safe in staphylococcal infections including endocarditis, osteomyelitis and septic arthritis. The once daily or alternate daily dosage allows home administration of treatment of infections caused by Staphylococcus aureus, including methicillin-resistant strains and enterococci with appreciable savings in hospital costs and improvement in the quality of life.

Anti-Bacterial Agents↗
PubMed2000

A prospective search for ocular lesions in hospitalized patients with significant bacteremia.

The purpose of this study was to determine the prevalence, risk factors, and prognostic value of ocular lesions in unselected patients with bacteremia. A total of 202 bacteremic patients, 101 nonbacteremic septic patients, and 90 nonseptic control patients were compared in a prospective, controlled, observational study. Ocular lesions related to bacteremia were found in 12% of the bacteremic group, 5% of the septic group, and 2% of the control group. Ocular lesions were significantly more frequent in the bacteremic patients than in the control patients (P=.007). The severity of the clinical condition and the presence of fungemia predict independently a higher risk of ocular lesions. Mortality rates among bacteremic patients with and without ocular lesions were, respectively, 32% and 8% (P<.01; OR, 3.99). The asymptomatic nature of most ocular lesions in patients with bloodstream infections and the impossibility of amelioration in most cases lead us to recommend ophthalmologic examination for bacteremic patients only when prognostic information is needed.

Adolescent↗