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Biomedical subjects

J Garau

Publications and source records attributed to J Garau.

At least 55 records · Page 3Linked to original sources
PubMed1998

Randomized clinical trial comparing two one-week triple-therapy regimens for the eradication of Helicobacter pylori infection and duodenal ulcer healing.

OBJECTIVE: One-week triple therapy has been shown to be effective in Helicobacter pylori eradication and duodenal ulcer healing. However, the optimal therapeutic combination has not yet been identified. Bismuth-containing regimens have the advantage of requiring only one antibiotic. It has been suggested that high doses of omeprazole improve the bactericidal efficacy of antimicrobial regimens against H. pylori. We evaluated the efficacy of two 1-wk triple-therapy regimens for H. pylori eradication and duodenal ulcer healing. METHODS: On an intention-to-treat basis, 182 patients with H. pylori-associated duodenal ulcer were randomized. Group OCB patients (n = 91) were given omeprazole 40 mg b.i.d., clarithromycin 500 mg b.i.d., and colloidal bismuth subcitrate 120 mg q.i.d. for 7 days. Group OCA patients (n = 91) were treated with omeprazole and clarithromycin at the same doses plus amoxicillin 1 g b.i.d., also for 7 days. Endoscopies were performed at entry and at 4 wk after the end of treatment. The presence of H. pylori was assessed by urease test, histology, Gram stain, and culture. No patient received follow-up treatment. RESULTS: H. pylori eradication rates achieved in the OCB and OCA groups were similar whether by intention-to-treat (82.4% vs 88.9% ;p = 0.21) or per protocol analysis (83.3% vs 89.9%; p = 0.19). Duodenal ulcer healing rates also were the same for OCB and OCA in intention-to treat (91.2% vs 91.1%) and per protocol analysis (92.2% vs 92.1%), respectively (p = 0.98). CONCLUSIONS: High rates of H. pylori eradication and duodenal ulcer healing were obtained with both short-treatment regimens, which were safe and well-tolerated. Colloidal bismuth subcitrate seems to be a good alternative to amoxicillin in the triple-therapy combination with omeprazole and clarithromycin. The omeprazole dose does not seem to play a major role in H. pylori eradication in these therapeutic combinations.

Adult↗
PubMed1998

Thoracic infection caused by Streptococcus milleri.

The objective of this study was to increase our understanding of the importance of members of the Streptococcus milleri (SM) group as respiratory pathogens, by studying the epidemiological and clinical features of thoracic infections caused by this group and comparing the epidemiology and prognosis of empyema caused by SM with cases of pneumococcal aetiology. The clinical histories and microbiology reports were reviewed in 27 cases of thoracic infection caused by SM over a period of 8 yrs. Cases of pneumococcal empyema that occurred during the same period were also analysed. Diagnoses were made of cases of empyema, including six with pneumonia and one with pulmonary abscess, three cases of pneumonia and two of mediastinitis. In 17 cases, SM was the only pathogen isolated. There was a history of instrument or surgical procedures on the digestive or respiratory tract in 59%. Secondary bacteraemia was documented in three cases. The treatment administered, a combination of antibiotics and surgery, was successful in 22 of 27 (81%) of cases. All strains were susceptible to penicillin. When the characteristics of the empyemas caused by monomicrobial SM infection were compared with those of pneumococcal aetiology from the same period of study, significant differences were found with respect to age, origin of the infection and the need for surgery. In conclusion, thoracic infections caused by Streptococcus milleri are largely pleural. They are polymicrobial in one-third of cases, commonly acquired in hospital and, in most patients, associated with major surgery and/or surgical procedures of the respiratory or digestive tract. The empyema frequently requires thoracotomy for complete resolution.

Anti-Bacterial Agents↗
PubMed1997

Prospective, randomised, multicentre study of meropenem versus imipenem/cilastatin as empiric monotherapy in severe nosocomial infections.

The clinical and bacteriological efficacy and the tolerability of meropenem versus imipenem/cilastatin (both 1 g t.i.d.) in severe nosocomial infections were compared in a multicentre, randomised, nonblinded study. A total of 151 patients were recruited; 133 (66 meropenem, 67 imipenem/cilastatin) were clinically evaluable and 84 (42 meropenem, 42 imipenem/cilastatin) bacteriologically evaluable. Most clinically evaluable patients (90%) were in intensive care units, required mechanical ventilation (72%), and had received previous antibiotic therapy (62%). The mean (+/- SD) APACHE II score was 15.2 (+/- 6.6) in the meropenem group and 17.8 (+/- 6.8) in the imipenem/cilastatin group. The primary infections were nosocomial lower respiratory tract infections (56% of patients), intra-abdominal infections (15%), septicaemia (21%), skin/skin structure infections (5%), and complicated urinary tract infections (3%); 35% of the patients had two or more infections. There was no significant difference between the meropenem and imipenem/cilastatin groups in the rates of satisfactory clinical (weighted percentage 87% vs. 74%) or bacteriological (weighted percentage 79% vs. 71%) response. There was a slightly higher rate of clinical success with meropenem against primary or secondary lower respiratory tract infection (89% vs. 76%). Drug-related adverse events occurred in 17% and 15% of meropenem and imipenem/cilastatin patients, respectively. Meropenem (1 g t.i.d.) was as efficacious as the same dose of imipenem/cilastatin in this setting, and both drugs were well tolerated.

Adolescent↗
PubMed1997

Group B streptococcal meningitis in adults: report of twelve cases and review.

Group B streptococcus (GBS) is the leading etiologic agent of bacterial meningitis and sepsis during the neonatal period, but it is an infrequent cause of meningitis in adults. We report 12 episodes of group B streptococcal meningitis in adults and review 52 cases reported in the literature. A total of 24 men and 40 women were included in the study; the mean age (+/- SD) was 49.2 +/- 20.5 years (range, 17-89 years). All the patients had cerebrospinal fluid cultures positive for GBS. Eighty-six percent of the patients had comorbid conditions, 50% had a distant focus of infection, and blood cultures yielded GBS for 78.7%. The overall case-fatality rate was 34.4% (22 patients). Factors associated with a poor outcome were advanced mean age (+/- SD) (61.5 +/- 17.4 years vs. 42.8 +/- 19.2 years; P = .0003) and the presence of complications on admission (P = .0001). Seven percent of survivors had neurological sequelae. Group B streptococcal meningitis in adults has become increasingly frequent in recent years; it tends to occur in patients with severe underlying conditions and is associated with a high case-fatality rate. Factors associated with a poor prognosis are advanced age and the occurrence of neurological and extraneurological complications.

Adult↗
PubMed1997

Epidemiology of an unusually prolonged outbreak of typhoid fever in Terrassa, Spain.

An unusually prolonged outbreak of typhoid fever, from 1988 to 1994, in Terrassa (Barcelona, Spain), was caused by a casual food handler who was a carrier. The pattern of this outbreak suggested intermittent low-level exposure to Salmonella typhi. We found 70 patients with S. typhi infections, 52 of whom were available for study. Medical records were reviewed and patients were interviewed with use of a standard questionnaire. Phage typing and pulsed-field gel electrophoresis (PFGE) for strain subtyping were used to confirm the epidemiological data. The 27 outbreak strains shared the same phage type and the same PFGE pattern. Four sporadic strains shared the same phage type as the outbreak strain. PFGE was found to be useful for differentiating strains for epidemiological purposes.

Adult↗
PubMed1997

[Cotrimoxazole plus rifampicin in the treatment of staphylococcal osteoarticular infection].

OBJECTIVE: To evaluate the efficacy and safety of cotrimoxazol plus rifampicin in staphylococcal osteoarticular infection. METHOD: Open, non-comparative study of adult hospitalized patients with documented staphylococcal bone infection. RESULTS: From Feb 1989 to Dec 1993 28 episodes of staphylococcal bone infection were treated in 14 men and 13 women; the mean age was 48 +/- 21 years (range, 11-84). They received cotrimoxazol (7 mg/kg/day of trimethoprim) plus rifampicin (600-1200 mg/day), both orally, every 8 to 12 h with a mean duration of treatment of 34.2 +/- 8.2 days (range, 21 to 55 days). This antibiotic regimen was initiated at the same time that appropriate surgery for each specific condition was undertaken. Diagnoses were postsurgical osteomyelitis (10 cases), infected total hip prostheses (4 cases, one with 2 episodes), osteomyelitis secondary to external pin fixation (5 cases), soft tissue infections linked to orthopedic implants (3 cases), two cases of metatarsal osteomyelitis (one diabetic foot and one patient with polineuropathy), and one case each of chronic osteomyelitis of femur, hematogenous lumbar spondylitis and posttraumatic osteomyelitis. Four patients had bacteremia. The duration of the infection, prior to surgery was less than one month in 12 episodes, 1 month to 2 years in 14, and in 2 cases, of 10 and 13 years, respectively. In 23 episodes the causal agent was Staphylococcus aureus and in 5 cases it was coagulase-negative staphylococci. Patients had received previous parenteral therapy with other antimicrobials during 2-40 days (X: 18.6 +/- 10.2 days). All patients but one had resolution of the infection and are currently asymptomatic 6 months to 5 years posttreatment in the 21 evaluable cases (X: 38 +/- 13.1 months). Five patients had adverse effects secondary to the antibiotic combination and in three these were severe enough to discontinue the antimicrobials. In no case of the 11 patients with post-treatment control cultures were staphylococci recovered from the wound. CONCLUSIONS: The combination of cotrimoxazole plus rifampicin, both given orally, was highly effective in this selected group of patients. This combination should be considered as a useful alternative therapy of staphylococcal bone infection and deserves further study.

Adolescent↗
PubMed1997

[Cerebral SPECT with thallium-201 in the differential diagnosis of focal cerebral lesions in patients with AIDS].

BACKGROUND: The aim of this study was to analyze the usefulness of cerebral SPECT with thallium-201 in patients with the acquired human immunodeficiency syndrome (AIDS) and focal cerebral lesions. METHODS: Six patients with AIDS and focal cerebral lesions in whom a cerebral SPECT was performed with thallium-201 are described. Treatment was initiated with antiToxoplasma drugs in all patients. The clinical response, serology for positive toxoplasma and radiologic improvement were criteria for the diagnosis of encephalitis by Toxoplasma. In the remaining cases, cerebral biopsy and/or necropsy study were carried out. RESULTS: In the 2 patients in whom cerebral SPECT demonstrated enhancement of the lesion, the pathologic diagnosis was cerebral lymphoma. Of the 4 remaining cases in whom no enhancement was observed, three corresponded to cerebral toxoplasmosis and one to progressive multifocal leucoencephalopathy. CONCLUSIONS: Cerebral SPECT with thallium-201 is a simple, specific and useful technique for the differentiation of primary cerebral lymphoma from the remaining inflammatory cerebral lesions which may be present in AIDS patients.

AIDS-Related Opportunistic Infections↗
PubMed1997

[The role of carbapenems in the treatment of nosocomial infection].

Carbapenems are active beta-lactam antibiotics versus most of the gram positive and gram negative microorganisms and anaerobes although their activity is lacking in the case of Staphylococcus sp. resistant to methicillin, Enterococcus faecium and Streptococcus pneumoniae with high resistance to penicillin and some gram negative bacilli which naturally produce an methaloenzyme able to hydrolyze them such as Stenotrophomonas maltophilia. Imipenem, the first synthetized carbapenem requires administration with cilastatin to avoid inactivation by renal dehydropeptidase 1. Meropenem does not require being taken with the renal enzyme inhibitor, with its activity being similar to that of imipenem. In abdominal infection the carbapenems have shown to be the authentic monotherapy in this type of infections being as effective as the different schedules of antibiotic associations normally used. Treatment with carbapenems in bacterial meningitis should be currently limited to the cases produced by gram negative bacilli producers of wide spectrum beta-lactamases (WSBL), cases of meningitis by Pseudomonas aeruginosa or gram negative bacilli producers of inducible cephalosporinase. Meropenem is the carbapenem of choice probably in these cases because the carbapenems are often the only active antibiotics and meropenem, specifically, does not have the risk of convulsions observed with imipenem-cilastatin. The carbapenems have shown to be useful in skin and soft tissue infections as well as in obstetric and gynecologic infections as monotherapy similar to the schedules of the currently used antibiotic associations. In the case of nosocomial pneumonias, all the studies have evaluated the carbapenems in monotherapy as useful and effective, specially in the case of pneumonia by gram negative bacilli. Finally, in non filiated nosocomial sepsis and specially in the case of neutropenic patients, the use of carbapenems is particularly attractive in gram negative sepsis in intensive care units. The appearance in the last few years of strains of gram negative bacilli, producers of wide spectrum beta-lactamase or stable repressed hyperproducers of class I chromosomic cephalosporinase, as well as other multiresistant gram negative bacilli, such as Acinetobacter baumanii make the carbapenems, in many cases, the only effective antibiotic in this type of infections.

Anti-Bacterial Agents↗
PubMed1996

Relationship between outer membrane protein profiles and resistance to ceftazidime, imipenem, and ciprofloxacin in Pseudomonas aeruginosa isolates from bacteremic patients.

Outer membrane protein (OMP) profiles of 122 Pseudomonas aeruginosa isolates recovered from the blood of bacteremic patients were analyzed to relate alterations in the expression of OMPs with porin activity to resistance to imipenem, ceftazidime, and ciprofloxacin. Imipenem-resistant isolates lacked or expressed reduced amounts of porin OprD. In contrast, alterations of OMP profiles were absent in most ceftazidime-resistant isolates. Six of 12 ciprofloxacin-resistant isolates had normal OMP profiles. The remaining isolates showed alterations in the expression of either OprC, OprF, or OprD. In addition, imipenem- and ceftazidime-resistant isolates displayed a beta-lactamase activity compatible with that of a group 1 chromosomal cephalosporinase.

Anti-Infective Agents↗
PubMed1996

Seven-year review of bacteremia caused by Streptococcus milleri and other viridans streptococci.

The Streptococcus milleri group is associated with a spectrum of serious suppurative infections that have not been well defined. The purposes of this study were to ascertain the clinical significance of Streptococcus milleri bacteremia and to determine the epidemiological, clinical, and microbiological features of these infections compared to those caused by other viridans streptococci. All cases of streptococcal bacteremia observed in a Spanish hospital in the period from January 1988 to December 1994 were reviewed. Of 137 cases of Streptococcus milleri infection, 33 (24%) were documented cases of bacteremia. Twenty-four patients were men (mean age 57.8 +/- 17.4 years). The majority of infections were abdominal in origin (20/33), the most frequent diagnoses being cholangitis/cholecystitis (18%) and appendicitis (12%). The origin of infection could not be established in three cases. Nine cases of bacteremia (27%) were polymicrobial. Six patients (18%) had septic shock; in four the infection was polymicrobial, and in two the infection was of abdominal origin. Eighteen of the 33 patients (54%) required surgery. Five patients died. All 33 Streptococcus milleri isolates were susceptible to penicillin. Twenty-two cases of bacteremia caused by other viridans streptococci were observed during the same period. There were no statistically significant differences between the two groups in terms of age, sex, mortality, rate of polymicrobial infection, rate of nosocomial acquisition of bacteremia, or the occurrence of shock. An abdominal origin of infection was more frequent in Streptococcus milleri bacteremia (p = 0.0001); a cardiovascular origin was more frequent in the viridans group (p = 0.01), as was a diagnosis of endocarditis (p = 0.004). Four patients with viridans streptococci bacteremia required surgery versus 18 patients with Streptococcus milleri bacteremia (p = 0.01). Viridans streptococci were notably less susceptible to penicillin (89%), clindamycin (79%), and erythromycin (79%).

Adolescent↗
PubMed1996

Clinical perspectives on the management of community-acquired pneumonia.

The management of community-acquired pneumonia requires the physician to start antibiotic treatment before the results of the sensitivity tests are known. To make a rational choice of antibiotic, a knowledge of the epidemiology of the disease is required with data on the susceptibility of the main pathogens to various antibiotics. Care must be taken to differentiate the "typical" from the "atypical" pneumonia. Increasing resistance among pneumococci to penicillin is causing considerable concern and, although increasing the dose is a strategy that currently works, a point will be reached in the future where new antibiotics will be required.

Adult↗