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Biomedical subjects

J J Picazo

Publications and source records attributed to J J Picazo.

At least 55 records · Page 3Linked to original sources
PubMed1999

Activities of new antimicrobial agents (trovafloxacin, moxifloxacin, sanfetrinem, and quinupristin-dalfopristin) against Bacteroides fragilis group: comparison with the activities of 14 other agents.

The antimicrobial activities of trovafloxacin, moxifloxacin, sanfetrinem, quinupristin-dalfopristin, and 14 other antimicrobial agents against 218 Bacteroides fragilis group strains were determined. A group of 10 imipenem-resistant strains were also tested. Imipenem, meropenem, and sanfetrinem had the lowest MICs of all of the beta-lactams. Quinupristin-dalfopristin inhibited all of the strains at 2 microg/ml. Overall, the MICs of trovafloxacin and moxifloxacin for 90% of the strains tested were 1 and 2 microg/ml, respectively.

Anti-Bacterial Agents↗
PubMed1999

[Bacteremia by Staphylococcus aureus: analysis of 311 episodes].

BACKGROUND: The aim of this study was to set up the differences between nosocomial and community acquired S. aureus bacteremia, to identify the features of the patients at high risk of endocarditis and to define the characteristics of the patients with methicillin resistant S. aureus (MRSA). METHODS: We prospectively studied 311 cases of S. aureus bacteremia detected at our hospital during a four-year period. RESULTS: Nosocomial acquisition of bacteremia was found in 63% of the cases, 45% of which were caused by MRSA. Nosocomial bacteria generally presented in older patients with more severe underlying conditions and a higher prevalence of invasive procedures than patients with the community-acquired disease. Likewise, the primary focus of infection was identifiable in most of the nosocomial episodes and mortality was also higher. Endocarditis presented in 19% of the bacteremia episodes and almost 90% of patients with endocarditis were intravenous drug users (IDU). The risk of endocarditis in this group was 64% whereas it was only 3% in non-IDU patients. Overall mortality was 33% and mortality directly due to the bacteremia was 22%. CONCLUSIONS: IDU patients were at high risk of endocarditis but most had a favourable outcome. Bacteremia was community-acquired in these patients and they rarely presented MRSA bacteremia. Patients with previous valvular diseases were at high risk of endocarditis and had a high mortality. Non-IDU patients with community-acquired bacteremia were at a low risk of endocarditis, regardless of whether a primary focus of infection had been identified or not. Mortality was lower in this group than in patients with nosocomial bacteremia and there were no cases of MRSA bacteremia. Mortality was higher in patients treated with vancomycin than in patients treated with other antibiotics active against S. aureus.

Adult↗
PubMed1999

[Bacteremias in a university hospital: study of etiologic agents and their sensitivity patterns].

OBJECTIVE: To determine the bacterial etiology of bacteremic episodes recorded at our hospital during 1995 and their antimicrobial susceptibility patterns. METHODS: The microbiological records of all bacteremic episodes detected at our hospital from January to December 1995 were analysed. The susceptibility patterns of the 334 gram-positive aerobic isolates to 11 antimicrobials and of 236 gram-negative aerobic isolates to 16 antimicrobial agents were determined. The reference agar dilution method was used for these determinations. RESULTS: The incidence of bacteremia was 19.3/1,000 admissions. Gram-positive aerobic bacteria accounted for 56.6% of monomicrobial bacteremias; the microorganisms recovered most frequently were coagulase-negative staphylococci (22.4%), Escherichia coli (16.5%) and Staphylococcus aureus (14.2%); 75 polymicrobial episodes were recorded. Over half of bacteremic episodes occurred at medical services. Hematologic diseases and solid tumours were the most common underlying diseases. No resistance to glycopeptides was observed among the staphylococci studied. The incidence of resistance to vancomycin in enterococci was small (1.5%). The aminoglycosides tested and some beta lactams showed good activity against the gram-negative bacilli studied. CONCLUSIONS: To carry out an epidemiologic surveillance of bacteremic episodes occurring at every hospital it is necessary to provide information on trends observed in the etiology of such infections, possible outbreaks, antimicrobial resistance, and uncommon pathogens.

Adolescent↗
PubMed1999

[Phenotypes of macrolide, lincosamide, and streptogramin resistant Streptococcus viridans isolated from blood].

Macrolide resistance has been widely studied in Streptococcus pyogenes and Streptococcus pneumoniae although not in viridans group streptococci (VGS). We studied 30 blood culture isolates of viridans group streptococci (25 resistant to erythromycin: 10 S. mitis, 8 S. milleri, 6 S. sanguis and 1 S. salivarius; and 5 susceptible: 2 S. mitis, 2 S. milleri and 1 S. sanguis). We carried out a double-disk test and determined MICs. The susceptibility testing was carried out by agar dilution for 14-, 15- and 16-member lactone ring macrolides, as well as for clindamycin and quinupristin-dalfopristin. Fifty-six percent of the erithromycin-resistant strains (6 S. mitis, 6 S. milleri and 2 S. sanguis) showed an MLS(B) phenotype, with a high level of intrinsic resistance to all the macrolides studied and clindomycin; 28% were of the M phenotype (4 S. sanguis, 2 S. mitis and 1 S. salivarius). We found a third resistance phenotype, which was present in 4 strains with MICs of 2-8 microg/ml, with resistance to macrolides and different degrees of resistance to clindamycin. All isolates were fully susceptible to quinupristin-dalfopristin. The MLS(B) and M phenotypes initially described in S. pyogenes and S. pneumoniae are also observed in VGS.

Anti-Bacterial Agents↗
PubMed1998

Hepatitis G virus infection in Spanish patients with hepatocellular carcinoma.

AIMS/BACKGROUND: To establish the rate of infection with a newly discovered Flaviviridae family member hepatitis G virus (HGV) -- in Spanish patients with hepatocellular carcinoma (HCC), chronic alcoholic liver disease (CALD) with cirrhosis, or hepatitis C virus (HCV)-induced chronic hepatitis (CH). METHODS: The presence of HGV-RNA was assessed in sera of 117 patients divided in three groups: group 1: 40 patients with HCC (35 men, mean age 62.7 years, SD 10.9 years); group 2: 41 patients with chronic alcoholic liver disease (CALD) (36 men, mean age 52.5 years, SD 9.8 years); group 3: 36 patients with HCV-induced CH (27 men, mean age 35.8 years, SD 8.5 years). Serum samples were tested for HGV-RNA by specific reverse transcriptase-polymerase chain reaction (RT-PCR). Serological markers of hepatitis B virus (HBV) and HCV were investigated in all patients and were negative in CALD patients, as a prerequisite for their inclusion in the study. All patients in group 1 were also tested for HBV-DNA. RESULTS: Rates of HGV-RNA positivity were, respectively, 47%, 10% and 28% in groups 1, 2 and 3. Differences were significant between groups 1 and 2 (p=0.00017) and groups 2 and 3 (p= 0.042), but not between groups 1 and 3 (p=0.079). CONCLUSIONS: HGV infection is common in HCC patients, but usually in association with HCV, indicating that both agents share common routes of infection. HGV was the only hepatitis virus detected in 12% of HCC patients, but its possible role in the pathogenesis of HCC remains unclear.

Adult↗
PubMed1997

Risk factors for developing clinical infection with methicillin-resistant Staphylococcus aureus (MRSA) amongst hospital patients initially only colonized with MRSA.

In hospital outbreaks of methicillin-resistant Staphylococcus aureus (MRSA) many patients are initially colonized without infection. The reasons why some progress to infection while others do not are not known. A cohort of 479 hospital patients, initially only colonized with MRSA, was followed prospectively for the development of MRSA infection. Risk factors for progression to infection were assessed using Cox proportional hazards survival analysis. Fifty-three patients (11.1%) developed 68 MRSA infections. Intensive care setting, administration of three or more antibiotics, ulcers, surgical wounds, nasogastric or endotracheal tubes, drains, and urinary or intravenous catheterization were all associated with increased rates of MRSA infection. Multivariate analysis showed that intensive care patients, compared with medical patients, had a higher rate of developing MRSA infection within the first four days of admission, with a hazard ratio of 26.9 (95% CI 5.7-126). Surgical wounds, pressure ulcers and intravenous catheterization were also independent risk factors, with hazard ratios (and 95% CI) of 2.9 (1.3-6.3); 3.0 (1.6-5.7) and 4.7 (1.4-15.6), respectively. These findings suggest that, during an MRSA outbreak, clinical infection would be reduced if surgical and intensive care patients received priority for the prevention of initial colonization with MRSA. Prevention of pressure ulcers, and strict aseptic care of intravenous catheters and surgical wounds would also reduce the development of MRSA infection. Since early treatment with vancomycin is known to reduce the mortality, patients colonized with MRSA who also have one or more of these risk factors may warrant empirical vancomycin therapy at the earliest suggestion of infection.

Adolescent↗
PubMed1996

Safety and efficacy of lamivudine-zidovudine combination therapy in zidovudine-experienced patients. A randomized controlled comparison with zidovudine monotherapy. Lamivudine European HIV Working Group.

OBJECTIVE: To compare the safety and efficacy of 2 doses of lamivudine given in combination with zidovudine with continued zidovudine monotherapy. DESIGN: Double-blind, randomized, multicenter, comparative trial of 223 patients treated for 24 weeks. SETTING: Patients from 32 hospitals in Europe were enrolled throughout a 1-year period. PATIENTS: Adult human immunodeficiency virus type 1 (HIV-1)-positive, zidovudine-experienced ( > or = 24 weeks prior zidovudine) patients with CD4+ cell counts between 0.10 and 0.40 x 10(9)/L (100-400 cells/microL). INTERVENTION: Patients received either 200 mg of zidovudine every 8 hours, 150 mg of lamivudine every 12 hours plus zidovudine, or 300 mg of lamivudine every 12 hours plus zidovudine for 24 weeks. All patients were then allowed to receive zidovudine and open-label lamivudine combination therapy. Twelve patients withdrew because of adverse events during the 24-week treatment period. MAIN OUTCOME MEASURES: Efficacy was measured by evaluating immunological and viral load changes, and safety was assessed by evaluating clinical manifestations and laboratory indexes of toxic effects. RESULTS: Patients receiving low- or high-dose combination therapy had greater treatment effects compared with patients receiving continued zidovudine monotherapy during the first 24 weeks as documented by changes in CD4+ cell counts (+0.04 vs +0.03 vs -0.02 x 10(9)/L, respectively; P < .001); log10 HIV-1 RNA as measured by the Roche assay (-0.96 vs -0.77 vs +0.07 copies/mL, respectively; P < .001) or log10 HIV-1 RNA measured by the quantitative nucleic acid sequence-based amplification assay (-0.59 vs -1.06 vs -0.02 copies/mL, respectively; P < .011); and immune-complex dissociated (ICD) p24 antigen (-74% vs -68% vs +27%, respectively; P < .001). There were no statistically significant differences in viral measurements, in CD4+ cell counts, or in safety profile between the groups receiving 2 doses of lamivudine in combination with zidovudine. The effects on CD4+ cell counts and ICD p24 antigen were sustained throughout 48 weeks for patients continuing combination therapy. Patients switching to combination therapy at week 24 showed improvement. CONCLUSION: In zidovudine-experienced HIV-1-infected patients, combination treatment with lamivudine and zidovudine is well tolerated and provides greater and more sustained increases in CD4+ cell counts and decreases in viral load than continued zidovudine monotherapy.

Adult↗
PubMed1996

Tuberculous meningitis. Clinical characteristics and comparison with cryptococcal meningitis in patients with human immunodeficiency virus infection.

OBJECTIVE: To determine the prevalence and causes of meningitis in patients with human immunodeficiency virus (HIV) infection. DESIGN: A prospective study of HIV-associated neurologic complications carried out from 1988 to 1992. SETTING: A tertiary care university hospital in Madrid, Spain. PATIENTS. A total of 142 patients, 65% of whom were injecting drug users. RESULTS: Thirty-six episodes of meningitis were diagnosed in 33 patients (23%). Of these, 17 cases (47%) were tuberculous meningitis (5 definite and 12 probable) and 7 (19%) corresponded to cryptococcal meningitis. Comparative studies of the tuberculous and cryptococcal meningitis cases showed injecting drug use as the most common form of HIV transmission in the tuberculous meningitis (P = .03) and a lower mean CD4+ cell count in the cryptococcal meningitis group (P = .02). CONCLUSIONS: Tuberculous meningitis was the prime type of meningitis, which was associated with HIV transmission by injecting drug use. Cryptococcal meningitis appears in more advanced stages of HIV infection, which determines its characteristic presentation.

Acquired Immunodeficiency Syndrome↗
PubMed1995

Autoantibodies to cryptic epitopes of C-reactive protein and other acute phase proteins in the toxic oil syndrome.

Toxic oil syndrome (TOS) was caused by the consumption of rapeseed oil contaminated with derivatives of aniline. Many persons who survived the acute phase developed a puzzling, multi-year chronic disease considered to be inflammatory or autoimmune in nature. In attempting to characterize their autoantibodies, we found that 74% of TOS patients with chronic disease had IgG antibodies to C-reactive protein (CRP). This activity was detectable only when CRP was chemically or physically denatured and behaved like a previously described antibody produced by immunization with the CRP monomer. Significant antibody reactivities to other acute phase proteins, especially alpha 1-antitrypsin and fibrinogen (P < 0.025) and ceruloplasmin (P < 0.05) were also observed. IgG antibodies to cryptic epitopes in CRP and other major serum proteins that increase during the acute phase response may reflect an earlier toxin-mediated insult to the liver that included abnormal biosynthesis of and/or damage to acute phase proteins.

Acute-Phase Proteins↗
PubMed1995

Mortality associated with nosocomial bacteremia due to methicillin-resistant Staphylococcus aureus.

We prospectively studied all cases of Staphylococcus aureus bacteremia that occurred during an extensive outbreak of methicillin-resistant S. aureus (MRSA) in our hospital over a 4-year period (January 1990 through September 1993). We report the results of a comparative analysis of the clinical characteristics and mortality rates among patients with nosocomial bacteremia caused by MRSA (84 cases) or methicillin-susceptible S. aureus (MSSA; 100 cases). The patients with MRSA bacteremia were older than those with MSSA bacteremia (69 years vs. 54 years, respectively; P < .01) and were more likely than those with MSSA bacteremia to have the following predisposing factors: a prolonged hospitalization (32 days vs. 14 days, respectively; P < .01); prior antimicrobial therapy (61% vs. 34%, respectively; P < .01); urinary catheterization (58% vs. 27%, respectively; P < .01); nasogastric tube placement (31% vs. 13%, respectively; P < .01); and prior surgery (45% vs. 31%, respectively; P = .05). Multivariate analysis with use of the stepwise logistic regression method showed a relationship between mortality and the following variables: methicillin resistance (odds ratio [OR], 3), meningitis (OR, 13), and inadequate treatment (OR, 11).

Aged↗
PubMed1995

[Beta-lactamase producing bacteria in the pharyngeal flora of patients with acute pharyngitis].

BACKGROUND: Production of beta-lactamase by normal pharyngeal flora could account for penicillin treatment failure in patients with acute streptococcal pharyngitis. The aim of the present investigation was to study the beta-lactamase-producing bacteria (BLPB) in 58 patients with acute pharyngitis, and to investigate the impact of two antibiotics, amoxycillin vs amoxycillin/clavulanic acid in the pharyngeal microflora. METHODS: Rapid antigen detection tests for S. pyogenes and standard microbiologic cultures were performed on simultaneously obtained throat swabs from each enrolled patient. Patients with group A streptococcal pharyngitis (GASP) were randomized in two groups: patients treated with 10 days of oral amoxycillin (group I), and patients treated with 10 days of oral amoxicyllin/clavulanic acid (group II). Patients without GASP and without antibiotic treatment were considered as controls (group III). Cultures were repeated 15 days following the first culture. All of them were processed for aerobic and anaerobic organisms. RESULTS: S. pyogenes was recovered in 25 patients (43.1%) and BLPB were isolated in 64% of the treated patients and in 78% of the non-treated control patients. We observed that the number of patients harboring BLPB did not change significantly in the untreated control group. After treatment we detected a similar increase in the number of patients harboring BLPB in groups I and II. In the present study BLPB were found in more than 70% of the patients and the failure rate was less than 10%. CONCLUSIONS: The results of this study indicate that production of beta-lactamase by pharyngeal organisms does not fully explain the failures of penicillin therapy for acute streptococcal pharyngitis.

Acute Disease↗