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Biomedical subjects

J Garau

Publications and source records attributed to J Garau.

At least 73 records · Page 4Linked to original sources
PubMed1996

[Fluoroquinolone and aminoglycoside resistance in chromosomal cephalosporinase-overproducing gram-negative bacilli strains with inducible beta-lactamase].

INTRODUCTION: The increasing prevalence of stable derepressed mutants over-producers of type I chromosomal cephalosporinase in inducible Enterobacteriaceae and Pseudomonas aeruginosa challenges the adequacy of third generation cephalosporins in the empirical treatment of certain nosocomial infections. We sought to determine the frequency of stable over-producers of type I enzyme and their associated resistance to fluoroquinolones and aminoglycosides. METHODS: Disc-diffusion and MIC determinations to extended-spectrum beta-lactams, imipenem, ciprofloxacin and gentamicin were performed in all cell isolates of inducible enteric bacteria (Enterobacter spp., Citrobacter spp., Serratia spp., Morganella morganii, Providencia spp.) and P. aeruginosa collected during the period of study (1992-1993). RESULTS: A total of 1,426 isolates of inducible enteric bacteria and P. aeruginosa were studied. Each one represented a single patient. Among the 511 isolates of enteric bacteria 15.1% of strains were found to be stable derepressed mutants (Serratia 2.2%; Morganella spp., 3%; Providencia and Proteus 3%; Citrobacter spp., 10%; Enterobacter spp., 23.6%); among the 916 P. aeruginosa isolates studied, 9.2% were stable over-producers. Among Citrobacter, Providencia and Proteus spp., 53.1% of stable over-producers were resistant to ciprofloxacin versus 20.2% of non-over-producers (p < 0.01); in P. aeruginosa, 35.3% of over-producers were resistant to gentamicin versus 25.0% in non-over-producers (p < 0.01). CONCLUSION: The prevalence of stable derepressed mutants is high among enteric bacteria and P. aeruginosa with type I inducible beta-lactamase. These strains frequently exhibit resistance to fluoroquinolones and aminoglycosides, reducing considerably the available therapeutic options.

Aminoglycosides↗
PubMed1995

Treatment of cerebral Aspergillosis with itraconazole: do high doses improve the prognosis?

We describe a 72-year-old woman with chronic asthma who presented with cerebral abscesses due to Aspergillus fumigatus after she received treatment with corticosteroids. Therapy with high-dose itraconazole (800 mg/d for 5 months, followed by 400 mg/d for an additional 4.5 months) resulted in complete resolution of all lesions. Serum concentrations of the drug ranged from 2 micrograms/mL to 30 micrograms/mL. Review of 20 cases of cerebral aspergillosis that were treated with itraconazole revealed that three of the four patients who received high doses (800 mg/d in the adults) of the drug responded favorably, while only two of the 16 patients who received a dose of 400 mg/d were cured. The use of high-dose itraconazole appears to be justified for high-risk patients with cerebral aspergillosis for whom conventional therapy has failed.

Aged↗
PubMed1995

Treatment of community-acquired pneumonia: a randomized comparison of sparfloxacin, amoxycillin-clavulanic acid and erythromycin.

The treatment of community-acquired pneumonia is empirical in most cases and must cover a wide range of potential pathogens, such as Streptococcus pneumoniae, including penicillin-resistant strains, Haemophilus influenzae and intracellular microorganisms. The objective of this double-blind, randomized, parallel group study was to compare the efficacy and safety of sparfloxacin (400 mg loading dose, followed by 200 mg o.d.) with that of oral amoxycillin-clavulanic acid (500/125 mg t.i.d.) or oral erythromycin (1 g b.i.d.), during 7-14 days in 808 patients with confirmed community-acquired pneumonia. The overall success rates for sparfloxacin (87%), amoxycillin-clavulanic acid (80%) and erythromycin (85%) were similar in evaluable patients, and the equivalence hypothesis used for the statistical analysis showed at least an equivalent efficacy for the three antibiotics tested. The analysis of microbiologically documented infections (40% of the patients) showed that overall success rates were similar for S. pneumoniae and H. influenzae infections. Treatment withdrawal was necessary in 3.5, 2.5 and 7.7% of the patients treated with sparfloxacin, amoxycillin-clavulanic acid and erythromycin, respectively. This study indicates that sparfloxacin was at least as effective as amoxycillin-clavulanic acid or erythromycin in the treatment of mild-to-moderate community-acquired pneumonia and that the adverse effects were similar in the three groups.

Adolescent↗
PubMed1995

Impact of colloidal bismuth subnitrate in the eradication rates of Helicobacter pylori infection-associated duodenal ulcer using a short treatment regimen with omeprazole and clarithromycin: a randomized study.

UNLABELLED: Recent trials have shown that duodenal ulcers treated by H2-blockers heal faster if Helicobacter pylori is eradicated concurrently. OBJECTIVES: To evaluate the efficacy of a short treatment regimen in H. pylori eradication and ulcer healing and to assess the impact of colloidal bismuth subnitrate (CBS) in H. pylori eradication rate. METHODS: Sixty-one patients with H. pylori-associated duodenal ulcer were randomized in two short treatment groups. Group A patients (31) were given omeprazole 20 mg b.i.d. x 8 days. Clarithromycin (500 mg, b.i.d.) and CBS (120 mg, q.i.d.) were added 24 h after starting omeprazole and were given for 7 days. Group B patients (30) were treated as group A patients but without CBS. Endoscopies were performed at entry and 4 wk after the end of treatment. Presence of H. pylori was assessed at each endoscopy by urease test, and biopsy specimens were examined for histological evidence of gastritis and by Gram stain and culture for H. pylori infection. No patient received follow-up treatment. RESULTS: H. pylori eradication rates were achieved in 25/31 (80.6%) group A patients and in 15/30 (50%) in group B patients (p = 0.012). Duodenal ulcer healing was documented in 30/31 (96.8%) patients in group A and in 25/30 (83%) patients in group B. CONCLUSIONS: The addition of CBS to the double therapy with omeprazole and clarithromycin substantially improves the eradication rate of H. pylori. Short therapy with omeprazole 20 mg/b.i.d., clarithromycin 500 mg/b.i.d., and CBS 120 mg/q.i.d. is a safe, well tolerated combination that achieves a 80.6% eradication rate of H. pylori and duodenal ulcer healing rates as good as those achieved by omeprazole 20 mg/d when given for 4 wk.

Antacids↗
PubMed1995

[Spontaneous mononucleosis caused by cytomegalovirus in the immunocompetent adult].

BACKGROUND: The first Spanish series of spontaneous infectious mononucleosis (IM) by cytomegalovirus (CMV) in immunocompetent adults is reported. METHODS: Patients whose clinical manifestations, physical exam, analysis and serology were compatible with acute CMV infection from 1984 to 1993 were retrospectively reviewed. RESULTS: Thirty patients with a mean age of 36 years fulfilled the diagnostic criteria. All presented fever, alone or associated with other symptoms, with a mean duration of 18 days, which persisted over 3 weeks in 36%. Physical exam showed lymph node enlargement (50%), hepatomegaly (33%), splenomegaly (20%) and was normal in 8 patients (26%). Mean leukocyte count was 9.75 x 10(9) (+/- 4.63 x 10(9) with more than 50% lymphomonocytic cells in 22 patients (76%) and reactive lymphocytes, principally from the outset, although this was observed on days 2 and 60 in 11 cases (36%). LDH, ASAT and ALAT were moderately elevated and ESR was normal. Serologic diagnosis was established from IgM (13%) seroconversion or positive IgM in the two samples with IgG four-fold increase (23%), as well as the presence of positive IgM and invariable high IgG in both determinations (26%) or all IgM positive titers in a single sample (36%). CONCLUSIONS: Infectious mononucleosis by cytomegalovirus is an infrequently diagnosed disease which should be considered in any young patient with fever despite a little demonstrative initial physical exam absence of atypical lymphocytes or a lack of diagnostic serology.

Adolescent↗
PubMed1994

[Loss of antibiotic sensitivity of Pseudomonas aeruginosa strains during treatment].

BACKGROUND: Loss of sensitivity to betalactamic, quinolones and aminoglucoside antibiotics has been described during treatment of infections produced by strains of Pseudomonas aeruginosa. Sixteen nosocomial strains isolated over a year during which sensitivity to one or several antibiotics of the above mentioned groups had been lost during the course of treatment were studied. METHODS: The strains were identified by conventional techniques. Sensitivity to antibiotics was studied by determination of the minimum inhibitory concentration in solid medium, according to the guidelines of the National Committee for Clinical Laboratory Standards. Plasmidic beta-lactamases were identified by analytic isoelectric focusing. Hyperproduction of chromosomic lactamase was studied by a qualitative technique. The 0 antigens were studied against rabbit antisera. The pyocinetype was determined according to the Fyfe method. Plasmids were detected by alkaline lysis extraction and electrophoresis in agarose gel. RESULTS: The 16 strains in which changes in sensitivity were observed during the course of treatment represent 4.47% of all P. aeruginosa isolates during one year. Loss of sensitivity to betalactamic antibiotics was observed in 10 strains, in one to aminoglucosides, in two to ciprofloxacin, simultaneously to aminoglucosides and ciprofloxacin in one and to betalactamic and ciprofloxacin in another two. Six of the 13 patients (46%) required a change in antibiotic treatment. CONCLUSIONS: The convenience of following the sensitivity of the strains of Pseudomonas aeruginosa isolated in a patients is suggested to thereby avoid therapeutic failure and the potential danger of clonal dissemination of the strains which have lost sensitivity.

Adult↗
PubMed1994

Beta-lactamases: current situation and clinical importance.

Production of beta-lactamases is the most important means of bacterial resistance to beta-lactam antibiotics. The traditional, plasmid-mediated beta-lactamases were initially confined to Enterobacteriaceae but have now spread to other genera and species including Pseudomonas aeruginosa, Haemophilus influenzae, and Neisseria gonorrhoeae. Extended-spectrum plasmid-mediated beta-lactamases have been identified in Enterobacteriaceae, particularly Klebsiella spp. and Escherichia coli. They are capable of hydrolyzing second- and third-generation cephalosporins and older beta-lactams. Chromosomally mediated beta-lactamases may be produced constitutively or induced by the presence of a beta-lactam. Mutation within the bacterial genome may lead to constitutive enzyme hyperproduction. Strains that produce these enzymes are resistant to practically all beta-lactams, with the exception of carbapenems. The wide-spread occurrence of antibiotic resistance dictates that therapies be judiciously chosen with attention to the resistance patterns of the causative organisms.

Anti-Bacterial Agents↗
PubMed1994

Prospective epidemiological study of invasive Haemophilus influenzae disease in adults.

The incidence and characteristics of invasive Haemophilus influenzae disease were studied in 43 adult patients admitted to the acute care hospitals in El Vallés County (Barcelona, Spain) between January 1987 and June 1992. The annual incidence of Haemophilus influenzae disease was 1.2 per 100,000 inhabitants. Pneumonia occurred in 24 patients, meningitis in five, intraabdominal infections in three, obstetric infections in two, epiglottitis in two and cellulitis in one. In six patients the source of infection was unknown. Ten (23%) of the infections were hospital acquired. Underlying conditions were diagnosed in 30 (70%) patients. Nontypeable Haemophilus influenzae strains predominated in all adult age groups. Sixty-one percent of type b and 34% of nontypeable strains were ampicillin resistant (p = 0.08). Multiple antibiotic resistance was also high among type b (53%) and nontypeable (18%) strains. The mortality rate was significantly higher in patients with pneumonia, bacteremia from an unidentified focus or shock at presentation.

Adolescent↗
PubMed1994

Predictive factors for invasive disease due to penicillin-resistant Streptococcus pneumoniae: a population-based study.

A prospective population-based study was carried out to determine predictive factors associated with penicillin-resistant pneumococcal invasive disease. A total of 374 patients (250 males and 124 females; mean age, 50.3 +/- 27 years) with invasive pneumococcal infection were admitted to one of the five hospitals in El Vallés County (an industrial area with 800,000 inhabitants in the province of Barcelona, Spain) over a period of 5 years. Of the 374 episodes, 21 (5.6%) were due to highly penicillin-resistant pneumococci and 67 (17.9%) to intermediately penicillin-resistant pneumococci. Multivariate analysis showed a statistically significant association between infection with intermediately penicillin-resistant pneumococci and an age of 0-4 years (odds ratio [OR] = 5.3; 95% confidence interval [CI] = 2.2-12.6), the presence of an immunosuppressive underlying disease (OR = 3.0; 95% CI = 1.5-6.0), and the previous use of beta-lactam antibiotics (OR = 2.1; 95% CI = 1.0-4.5). Infection with highly penicillin-resistant pneumococci was associated only with the previous use of beta-lactam antibiotics (OR = 5.9; 95% 95% CI = 2.2-15.8). Highly resistant strains were of serotypes 6, 9, 14, 15, 19, and 23, of which all but serotypes 9 and 15 are included in the newly formulated conjugated vaccine.

Adolescent↗
PubMed1994

Lung cavitation associated with Pneumocystis carinii infection in the acquired immunodeficiency syndrome: a report of six cases and review of the literature.

Lung cavitation in patients with the acquired immune deficiency syndrome (AIDS) and Pneumocystis carinii pneumonia (PCP) has mainly been reported as single case studies. Among 160 episodes of PCP seen in a 1,000 bed teaching hospital and a 600 bed teaching hospital from 1985-1992, we found six cases presenting with lung cavitation and documented Pneumocystis carinii infection. In the cases we report, as well as in the cases reviewed, cavities appear either alone or within an area of pulmonary consolidation, a mass or a nodule. They may present with haemoptysis, show unusual locations, and, most importantly, may frequently be misdiagnosed by bronchoalveolar lavage.

AIDS-Related Opportunistic Infections↗
PubMed1994

[Hip prosthesis infection: diagnostic approach and treatment of 27 cases].

BACKGROUND: Preoperative diagnosis of hip prosthesis infection (HPI) is difficult. There is no therapeutic option which is completely effective and without risk. The aim of this study was to evaluate a diagnostic approach and therapeutic strategy in a group of patients with HPI. PATIENTS AND METHODS: A retrospective study of 27 episodes of HPI diagnosed by anatomopathologic and/or microbiologic examination of surgical samples was performed. RESULTS: Twenty-three patients with 27 episodes of HPI out of a total of 24 hip prosthesis (HP) were treated. The infection was early in 15 episodes. The etiologic agents were plasmocoagulase negative staphylococcus (NSP) in 11 cases, P. aeruginosa in 8, S. aureus in 5, Enterococcus sp. in 2 and miscellaneous in the remaining cases. In 2 cases the infection was polymycrobial. Following a mean follow period of 22.6 +/- 15.2 months, 13 out of the 14 patients in whom the prosthesis was withdrawn were cured (in 4 a second prosthesis was implanted), one out of 6 in those in whom the prosthesis remained in situ following debridement, and 2 out of 3 episodes in whom reimplantation was performed over time. The withdrawal of the prosthesis was significantly greater than debridement in the treatment of early infection (p < 0.001). The total mean length of postoperative antibiotherapy was 48.2 +/- 17 days. No differences were observed in the oral versus parenteral treatment (p = 0.22), and nor was prognosis worse in those treated for less than 42 days. CONCLUSIONS: The authors' experience suggests that attempts to save a hip prosthesis in early infection usually fail. In addition to prosthesis withdrawal or implantation of another prosthesis, six weeks of postoperative antibiotic therapy, which may be oral route, appear to be sufficient.

Aged↗
PubMed1994

Resistant pneumococci: a renewed threat in respiratory infections.

The emergence of penicillin-resistant Streptococcus pneumoniae (PRSP) is an international problem which has been compounded by the development of high-level, multiple resistance to other beta-lactam antibiotics. Resistance develops in a 'step-wise' but unpredictable manner due to the mutation of penicillin-binding proteins (PBP). This results in a high degree of heterogeneity between bacterial strains. Such mutations can result in the rapid emergence of antibiotic resistance, including extended-spectrum cephalosporins, with reported minimum inhibitory concentration (MIC) values of up to 32 mg/l. The effective treatment of diseases caused by such organisms is dependent upon rapid assessment of antibiotic sensitivities. Therefore, MIC values of a range of antibiotics must be determined in cases of treatment failure and in serious pneumococcal infections. However, pharmacokinetic properties, as determined by the inhibitory quotient, which reflect drug concentrations attainable in different tissues, should also be considered. Beta-lactam antibiotics with good inhibitory activity against pneumococci include: amoxycillin, cefotaxime, ceftriaxone, cefpirome and imipenem. Nevertheless, as the prevalence of PRSP strains is likely to increase, new therapeutic strategies may have to be adopted.

Anti-Bacterial Agents↗
PubMed1993

Tamoxifen failure in medullary thyroid carcinoma.

We report the results of short-term tamoxifen treatment (20 mg two times a day orally) in 2 patients with metastatic medullary thyroid carcinoma. Patient A had a rapid tumor progression with development of Cushing's syndrome before initiation of tamoxifen treatment. Patient B had a slowly progressive course. In both cases, neither clinical nor biochemical improvement were observed, after 1 and 3 months of tamoxifen therapy, respectively.

Adult↗
PubMed1993

Ciprofloxacin and trimethoprim-sulfamethoxazole versus placebo in acute uncomplicated Salmonella enteritis: a double-blind trial.

The role of ciprofloxacin and trimethoprim-sulfamethoxazole (TMP-SMZ) was evaluated in empiric treatment of uncomplicated Salmonella enteritis in a comparative, double-blind trial. Patients were randomized to receive ciprofloxacin (500 mg), TMP-SMZ (160/800 mg), or placebo orally twice daily for 5 days. There were 65 evaluatable patients with acute, uncomplicated, culture-confirmed Salmonella enteritis. Duration of diarrhea, abdominal pain, or vomiting and time to defervescence were not significantly different for patients treated with ciprofloxacin, TMP-SMZ, or placebo; there also were no significant differences with respect to full resolution of symptoms for ciprofloxacin versus placebo (point estimate, 0.2 days; 95% confidence interval [CI], -0.5 to 0.9 days) or for TMP-SMZ versus placebo (point estimate, 0.2 days; 95% CI, -1.0 to 0.6 days). The rate of clearance of salmonellae from stools was not significantly different among the groups.

Acute Disease↗
PubMed1992

Postoperative complications due to methicillin-resistant Staphylococcus aureus (MRSA) in an elderly patient: management and control of MRSA.

An elderly lady was admitted to hospital for elective resection of an adenocarcinoma of the colon. Following an anastomotic leak she developed intra-abdominal sepsis and underwent abdominal drainage of pus. During recovery from her second operation, she developed pneumonia and a bacteraemia due to methicillin-resistant Staphylococcus aureus (MRSA). She was treated with vancomycin and co-trimoxazole and survived without further sequelae. Details of the development and treatment of this case are discussed. Procedures for the control and eradication of MRSA infections in hospitals are reviewed.

Adenocarcinoma↗