RESUMEN

OBJECTIVES: Performance evaluation of routine laboratory methods to determine the susceptibility of Enterobacterales urinary isolates to fosfomycin (oral administration) and mecillinam. METHODS: We collected 347 Enterobacterales isolates from monomicrobial midstream urine samples from women with significant bacteriuria and leukocyturia. Mostly non-Escherichia coli isolates (i.e. Klebsiella spp., Citrobacter koseri, Enterobacter cloacae complex and Proteus mirabilis) were included (n = 298). Performance of VITEK®2, ETEST®, and disc diffusion to determine fosfomycin and mecillinam susceptibility was evaluated following International Organization for Standardization (ISO) 20776-2:2021 (or 20776-2:2007 for disc diffusion) in comparison with the agar dilution reference method. RESULTS: For fosfomycin testing, VITEK®2 and ETEST® were close to reaching ISO requirements (essential agreement  ≥ 90%; bias  ±30%) for C. koseri, E. coli and P. mirabilis. Categorical agreement (CA) and major error rates were acceptable for disc diffusion. Fosfomycin displayed lower activity against E. cloacae complex and Klebsiella spp., with MIC50 (minimum inhibitory concentration required to inhibit the growth of 50% of tested isolates) equal to the E. coli EUCAST breakpoint (8 mg/L). For these species, the three alternative techniques overestimated MICs and resistance, and did not meet performance criteria. For mecillinam testing of Enterobacterales isolates, apart from P. mirabilis, ETEST® nearly fulfilled ISO requirements, and CA rates were acceptable for disc diffusion. ISO criteria were reached for C. koseri and E. coli testing with VITEK®2, apart from too high rates of very major errors. For P. mirabilis, performances were unacceptable, whatever the routine method used. CONCLUSIONS: Commercially available tests may serve as alternatives to agar dilution to assess fosfomycin (oral) and mecillinam susceptibility of Enterobacterales urinary isolates, with important interspecies variabilities. Additional studies comprising more fosfomycin- and mecillinam-resistant isolates are needed to strengthen our conclusions.

RESUMEN

Fosfomycin is a phosphonic acid derivative active against a wide spectrum of Gram-positive and Gram-negative pathogens. It is used for the treatment of uncomplicated urinary tract infections (uUTI) or severe infections by oral or intravenous (i.v.) administration. In order to improve its performance and robustness, the fosfomycin strip, an antibiotic gradient diffusion strip, was redeveloped and evaluated in the multicenter study summarized in this paper. ETEST fosfomycin (ETEST FO) clinical performance was evaluated by three study sites on 152 Enterococcus faecalis, 100 Staphylococcus spp. and 330 Enterobacterales in comparison with the CLSI and EUCAST agar dilution reference method. Referring to FDA performance criteria, the ETEST FO achieved 91.0% of essential (EA) and 99.0% of categorical agreement (CA) for Escherichia coli. In addition, 98.0% EA and 93.4% CA were achieved for E. faecalis, with no very major errors (VME) or major errors (ME). According to EUCAST breakpoints for intravenous fosfomycin use, Enterobacterales and Staphylococcus spp. also met ISO acceptance criteria for EA and CA (EA 91.5%, 94.0%, respectively, and CA 98.0% for both). A VME rate of 8.8% was observed for Enterobacterales but the MICs were within EA. A trend to predict lower MICs for Citrobacter spp., E. coli and Salmonella enterica and to predict higher MICs for Klebsiella pneumoniae MICs was observed, while ETEST FO should not be used for Enterobacter cloacae, because of low EA and a high VME rate. The study results support the efficiency of the novel ETEST FO, making it an easy-to-handle tool as a substitute to the classical agar dilution method.

Asunto(s)

RESUMEN

Rheumatologic manifestations, ectopic calcification and hypercalcemia of adrenal insufficiency (IS) were evaluated by a prospective study (S1) of 20 patients with IS and a retrospective analysis of 93 cases of IS (S2). When routine investigations were conducted they revealed very frequent osteoarticular lesions (19 of 20 cases, S1). Painful manifestations (arthralgia, myalgia), variable with fluctuations in the IS affection were observed in both groups (S1, S2). Analysis of group S1 showed a high number of periarthritic attacks (9 of 20 cases), and a significantly higher incidence of tendinous calcifications (p less than 0.03) and of multiple tendinous calcification disease (MCTM) (p less than 0.05) in relation to 20 matched controls. This combined affection MCTM-IS has not been reported previously. Calcification could be due to glucocorticoid deficiency, the only common factor for all cases, and the frequent calcification of ear pinna (greater than 30% of cases in the 2 groups) could be related to the same deficiency. Finally, reported in the 81 case-reports were 18 episodes of hypercalcemia, emphasizing the unrecognized frequency of this disturbance whose determining role is unclear.

Asunto(s)

Asunto(s)

RESUMEN

We conducted a prospective study of the rheumatological manifestations in 20 patients with adrenal failure: 15 women and 5 men with a mean age of 56. Osteo-articular pathology was observed in 19 of the 20 cases (95%). The painful manifestations presented as arthralgia, myalgia or episodes of peri-arthritis; they were associated with active phases of the endocrine disease in 9 cases (45%). The radiological features of these patients were compared with those of age and sex matched controls who were hospitalized for other rheumatological conditions. 11 patients had radiologically visible tendinous calcifications (TC); 6 patients had 3 or more TC. The 20 patients had a total of 31 TC, which was significantly different from the controls. A related finding was calcification of the cartilages of the ears in 4 out of 10 patients (40%). Hypercalcaemia was detected in 5 cases (25%), accompanying episodes of decompensation of the adrenal failure. The pathogenesis of the tendinous calcifications is not clear. Mineralocorticoid treatment can not be considered to be a major aetiological factor for CT, calcification of the ears nor the pain, as its use was very constant. Thus, tendinous calcifications, which have rarely been reported to date, could explain a large part of the painful manifestations of adrenal failure.

Asunto(s)

Asunto(s)