RESUMEN
Two seriously neutropenic patients (a 23-year-old man with a promyelocytic acute myeloid leukemia [AML-M3] and a 77-year old male with an immature acute myeloid leukemia [AML-M1] diagnosis) with severe infections caused by Stenotrophomonas maltophilia were treated with aztreonam/clavulanic acid (2:1) combination. In the first patient the infection was caused by a multiresistant strain and in the second, by a strain with poor response to trimethoprim-sulfamethoxazole and other antimicrobial agents. After treatment with aztreonam/clavulanic acid both patients evolved favorably.
Asunto(s)
Aztreonam/uso terapéutico , Ácidos Clavulánicos/uso terapéutico , Quimioterapia Combinada/uso terapéutico , Infecciones por Bacterias Gramnegativas/tratamiento farmacológico , Neutropenia/etiología , Xanthomonas/efectos de los fármacos , Adulto , Anciano , Ácido Clavulánico , Resistencia a Múltiples Medicamentos , Infecciones por Bacterias Gramnegativas/complicaciones , Humanos , Leucemia Mieloide/complicaciones , MasculinoRESUMEN
BACKGROUND: In this study, we compared and evaluated the efficacy of five culture media for the primary isolation of Helicobacter pylori from gastric biopsies. MATERIALS AND METHODS: A total of 1,174 biopsies (antrum and corpus) taken from 587 patients were plated in parallel on two selective media--Skirrow's medium and brain-heart infusion (BHI) agar supplemented with 10% sheep blood, polymyxin B, vancomycin, trimethoprim, and amphotericin B (HPA medium), and on three nonselective media--chocolate agar with Isovitalex, Columbia blood agar, and BHI-10% sheep blood agar. RESULTS: An isolation rate of 57.9% (680 of 1,174) was obtained with a combination of all media. HPA medium gave the highest isolation rate, 99.4% (676 of 680). Chocolate agar, Columbia blood agar, brain-heart blood agar, and Skirrow's medium showed very poor performance (23.5%, 28.5%, 65.9%, and 71% of all isolates, respectively). The number of cultures in HPA medium discarded due to contamination was only 2 (0.32%). There was no difference in the positive rate of culture in HPA medium between the antrum and the corpus of the stomach. CONCLUSIONS: The HPA medium is superior to Skirrow's medium and nonselective media in promoting growth of H. pylori and, on the basis of these results, we recommended the use of HPA medium for primary isolation of H. pylori from gastric biopsies.