RESUMEN

Clinical outcome of 23 patients with mixed endometrioid and serous endometrial carcinomas (mixed EEC-SC) was compared to that of pure endometrioid (EEC) and pure serous (SC) carcinomas. Hotspot mutation frequencies in KRAS, PIK3CA, PTEN, and TP53 and microsatellite instability (MSI) status were determined in mixed EEC-SC, as well as in their EEC and SC microdissected components separately, and alterations were compared to frequencies in pure EEC and SC. Relapse-free (RFS) and overall survival (OS) differed significantly between mixed EEC-SC and pure EEC and SC, revealing that outcome of mixed EEC-SCs was intermediate to that of pure EEC and pure SC. PTEN mutations were absent in pure SC, but occurred in 20 % of pure EEC, and 13 % of mixed EEC-SC. In contrast, TP53 mutations were more frequent in pure SC (17 %) and mixed EEC-SC (22 %) than in pure EEC (2 %). Mutations in mixed EEC-SC were shared by the two microdissected components in 30 %, whereas in 35 %, some mutations were component-specific. Mutation analysis confirms similarities between the EEC and SC components of mixed EEC-SC with pure EEC and pure SC, respectively. However, PTEN and KRAS mutations were more frequent in the SC component of mixed EEC-SC than in pure SC, while TP53 mutations were more frequent in the EEC component of mixed EEC-SC than in pure EEC. Presence of different clonal mutation pattern between EEC and SC components of mixed EEC-SC raises the possibility of divergent tumor heterogeneity or biclonal origin in some cases.

Asunto(s)

Carcinoma Endometrioide/genética , Cistadenocarcinoma Seroso/genética , Neoplasias Endometriales/genética , Neoplasias Complejas y Mixtas/genética , Anciano , Carcinoma Endometrioide/mortalidad , Carcinoma Endometrioide/patología , Cistadenocarcinoma Seroso/mortalidad , Cistadenocarcinoma Seroso/patología , Análisis Mutacional de ADN , Supervivencia sin Enfermedad , Neoplasias Endometriales/mortalidad , Neoplasias Endometriales/patología , Femenino , Humanos , Estimación de Kaplan-Meier , Persona de Mediana Edad , Neoplasias Complejas y Mixtas/mortalidad , Neoplasias Complejas y Mixtas/patología , Modelos de Riesgos Proporcionales

RESUMEN

OBJECTIVES: There is paucity of data on the capacity of fetal membranes to repair surgical defects following trauma. We aimed at developing an in vitro model using monolayers of human amnion epithelial cells to study fetal membrane healing. METHODS: Term (n = 6) and preterm (n = 3) fetal membranes were collected at caesarean section. The amnion was digested twice in a trypsin solution. Amniocytes were seeded (250,000-750,000/ml) and incubated at 37 degrees C and 5% CO(2) and 21 or 5% O(2). A microsurgical injury was made centrally in the monolayers and the cultures were incubated for 48 h. Every 6 h, slides were fixed and immunohistochemical staining was performed to quantify proliferation at the site of the defect and centrally in the monolayer. The closure rate was evaluated by measuring the defect size every 6 h. RESULTS: The closure rate of the defects was higher in preterm versus term cultures. Proliferation was significantly higher in the defect zone versus the peripheral zone, and also higher in the preterm group. CONCLUSION: We describe a new model for the study of fetal membrane healing and observed gestational age-dependent repair capacity of the amnion.

Asunto(s)

Amnios/lesiones , Amnios/fisiología , Membranas Extraembrionarias/lesiones , Membranas Extraembrionarias/fisiología , Cicatrización de Heridas/fisiología , Amnios/citología , Procesos de Crecimiento Celular/fisiología , Femenino , Edad Gestacional , Humanos , Técnicas In Vitro , Embarazo

RESUMEN

Uterine adenosarcoma (UAS) is microscopically characterized by a biphasic growth pattern. By definition, the epithelial component is benign, whereas the stromal component typically has the appearance of a low-grade sarcoma, usually an endometrial stromal sarcoma. CD10 acts by reducing cellular response to peptide hormones and is currently regarded as a specific marker for endometrial stromal tumors. In this international multicenter study, we further explored CD10 immunoreactivity in 30 UASs. We encountered CD10 positivity of the sarcomatous component in 18/20 (90%) of UASs, in five of eight (63%) of UASs with sarcomatous overgrowth as well as in both cases of recurrent UAS. The epithelial component stained negative in all cases. These findings suggest that CD10 can be used to differentiate UAS from cellular leiomyoma, or in case endometrial stromal cells exhibit muscle differentiation. Furthermore, CD10 positivity in recurrent UAS might guide the pathologist toward an endometrial stromal origin.

Asunto(s)

Adenosarcoma/metabolismo , Biomarcadores de Tumor/metabolismo , Neprilisina/metabolismo , Neoplasias Uterinas/metabolismo , Adenosarcoma/epidemiología , Adenosarcoma/etiología , Adenosarcoma/patología , Adulto , Anciano , Anciano de 80 o más Años , Europa (Continente)/epidemiología , Femenino , Humanos , Inmunohistoquímica , Leiomioma/epidemiología , Leiomioma/etiología , Leiomioma/metabolismo , Leiomioma/patología , Persona de Mediana Edad , Valor Predictivo de las Pruebas , Neoplasias Uterinas/epidemiología , Neoplasias Uterinas/etiología , Neoplasias Uterinas/patología

RESUMEN

The incidence of penicillin- and erythromycin-resistant strains of Streptococcus pneumoniae has increased considerably in Belgium. The medical charts of all patients with pneumococcal bacteraemia who were admitted to hospital over a period of 3 years (n = 136) were reviewed to identify treatment failure of outpatient antibiotic therapy. Twelve patients had received antibiotics for at least 48 h prior to admission. Four treatment failures received clarithromycin as pre-hospitalization therapy, and S. pneumoniae from all four patients were highly resistant to macrolides. Five patients failed on co-amoxiclav, whereas their S. pneumoniae were susceptible to penicillin and amoxicillin. This observation suggests that macrolide resistance is clinically relevant and leads to treatment failure, whereas suboptimal dosing may explain breakthrough pneumococcal bacteraemia in beta-lactam-treated patients.

Asunto(s)

Bacteriemia/tratamiento farmacológico , Claritromicina/administración & dosificación , Farmacorresistencia Bacteriana , Infecciones Neumocócicas/tratamiento farmacológico , beta-Lactamas/administración & dosificación , Administración Oral , Adulto , Anciano , Anciano de 80 o más Años , Bacteriemia/epidemiología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Infecciones Neumocócicas/epidemiología , Estudios Retrospectivos , Insuficiencia del Tratamiento , Resistencia betalactámica

RESUMEN

OBJECTIVES: We studied collagen plugging of the fetoscopic access site in an in vivo fetal lamb model for fetoscopic surgery and possible role for matrix metalloproteinase (MMP)-2 and -9 and tissue inhibitors (TIMPs). METHODS: Eight ewes had fetoscopic balloon occlusion of the trachea as an experimental treatment for congenital diaphragmatic hernia between days 88 and 99 of gestation (term 145 days) with sampling of amniotic, allantoic, and tracheal fluid. Nonoperated cotwins were used as controls. The fetoscopy port was closed using a collagen plug. Ten days (range 9-12) later, fluids were sampled and plug sites collected for histologic analysis. Activity of MMP-2 (72 kDa, gelatinase A) and MMP-9 (92 kDa, gelatinase B) was determined in the fluids by zymography and secretion of TIMPs (27-30 kDa; TIMP-1, glycosylated TIMP-3 and TIMP-4, 24 kDa; unglycosylated TIMP-3, 21 kDa; TIMP-2) by reverse zymography and quantified by densitometric analysis. RESULTS: No pregnancy was complicated by amniorhexis or preterm labor. At cesarean, normal volumes of amniotic and allantoic fluid were present in all cases. Histology of the plug sites revealed good integration of the collagen plug without complete restoration of membrane integrity. MMP-2, MMP-9, and TIMPs were detected in all fluids. In the operated animals, significantly (P <.05) higher activity of MMP-9 was found in amniotic fluid, with lower concentrations of TIMPs in allantoic fluid (P <.01). Tracheal occlusion was associated with a significant (P <.02) increase in both MMP-2 and -9 in tracheal fluid. CONCLUSION: Collagen plugging of the fetoscopic access port sites in sheep resulted in functionally effective sealing of the fetal membranes. Changes in MMP-2, MMP-9, and TIMPs suggest an active remodeling of both the fetal lung and the fetal membranes.

Asunto(s)

Fetoscopía/métodos , Metaloproteinasa 2 de la Matriz/metabolismo , Metaloproteinasa 9 de la Matriz/metabolismo , Inhibidores Tisulares de Metaloproteinasas/metabolismo , Amnios/citología , Amnios/enzimología , Líquido Amniótico/química , Líquido Amniótico/enzimología , Animales , Corion/citología , Corion/enzimología , Modelos Animales de Enfermedad , Femenino , Edad Gestacional , Neutrófilos/fisiología , Embarazo , Ovinos , Inhibidor Tisular de Metaloproteinasa-1/metabolismo , Inhibidor Tisular de Metaloproteinasa-2/metabolismo , Inhibidor Tisular de Metaloproteinasa-3/metabolismo , Inhibidor Tisular de Metaloproteinasa-4

RESUMEN

In Belgium more than 17% of the invasive pneumococci are not susceptible to penicillin, and more than 38% not to macrolides. The most prevalent mechanism of macrolide resistance in Europe is modification of the drug target site leading to cross-resistance to lincosamides and group B streptogramines (MLSB resistance). Telithromycin is the first antibiotic of the family of ketolides, which differ from erythromycin by having a 3-keto group instead of the neutral sugar L-cladinose. We tested the susceptibility of 637 pneumococci, recently isolated from patients in Belgium, to telithromycin and five other antibiotics. Data generated by this study show that telithromycin inhibits 98.4% of pneumococci at a breakpoint concentration of 1 mg/L in spite of a high percentage (> 30%) of strains with the MLSB constitutive type of resistance. Susceptibilities to the five comparator drugs were: penicillin (81.8%), tetracycline (67.0%), levofloxacin (98.9%), erythromycin (61.5%) and clindamycin (66.6%). Consequently telithromycin looks to have considerable potential for the empiric treatment of community-acquired respiratory tract infections.

Asunto(s)

Antibacterianos/farmacología , Cetólidos , Macrólidos , Streptococcus pneumoniae/efectos de los fármacos , Streptococcus pneumoniae/aislamiento & purificación , Bélgica/epidemiología , Farmacorresistencia Microbiana , Humanos , Pruebas de Sensibilidad Microbiana , Sensibilidad y Especificidad , Infecciones Estreptocócicas/tratamiento farmacológico , Infecciones Estreptocócicas/epidemiología

RESUMEN

Ordinary bone wax was used to stop bleeding from the iliac crest after procurement of autogenous bone graft harvesting. This gave rise to a large, symptomatic retroperitoneal tumor, which had to be removed operatively 19 years later. Microscopically, a bone wax granuloma was diagnosed. As far as the authors know this is the first case reported with such late and severe clinical complications after the use of bone wax.

Asunto(s)

Trasplante Óseo/efectos adversos , Granuloma/etiología , Donantes de Tejidos , Ceras/efectos adversos , Adulto , Femenino , Granuloma/patología , Hemorragia/prevención & control , Humanos , Enfermedades Peritoneales , Trasplante Autólogo , Ceras/uso terapéutico

RESUMEN

OBJECTIVES: We aimed to set up an organ culture of human amniochorion to evaluate fetal membrane repair capacity following surgical trauma. METHODS: Fetal membranes were collected from four patients, during elective caesarean section at term. Explants were traumatised at the centre and cultured on collagen support material for a total of 12 days. Viability was assessed by light microscopy and proliferation by detection of 5-Bromo-2' deoxy-Uridine (BrdU) incorporation and immunohistochemistry. Wound healing capacity was assessed trough photographic documentation every 2 days. RESULTS: Cultures showed good survival for 12 days. Increased cellularity, survival and proliferations were observed at the borders of the cultures in contrast to the central trauma site. During the 12 days observation period, no significant closure of the membrane defect could be demonstrated. CONCLUSION: This organ culture system represents a new model for the study of human fetal membrane repair. Despite good survival and localised proliferation, no obvious closure of a surgically created defect was observed in the described culture conditions.

Asunto(s)

Membranas Extraembrionarias/lesiones , Técnicas de Cultivo de Órganos/métodos , Cicatrización de Heridas/fisiología , Membranas Extraembrionarias/patología , Humanos

RESUMEN

The genetic basis of macrolide resistance was characterized in 59 Streptococcus pneumoniae isolates. All isolates were collected in 1995 and 1997 and were from invasive infections. The majority of the isolates (54 of 59 isolates) were erythromycin and clindamycin resistant (MLS(B)-phenotype) and carried the ermAM gene. Five isolates were erythromycin resistant but clindamycin susceptible (M-phenotype). Using PCR the mefE gene was detected in these five isolates. Contrary to the situation found in Canada and the USA, mefE-mediated erythromycin resistance in S. pneumoniae is uncommon in Belgium.

Asunto(s)

Antibacterianos/farmacología , Metiltransferasas/genética , Streptococcus pneumoniae/efectos de los fármacos , Bélgica , ADN Bacteriano/aislamiento & purificación , Farmacorresistencia Microbiana/genética , Eritromicina/farmacología , Humanos , Concentración de Iones de Hidrógeno , Pruebas de Sensibilidad Microbiana , Streptococcus pneumoniae/genética

RESUMEN

OBJECTIVE: To follow the evolution of capsular types and resistance of Streptococcus pneumoniae, isolated from deep sites. METHODS: More than 100 Belgian laboratories permanently collect S. pneumoniae strains isolated from puncture specimens (blood, cerebrospinal fluid, middle ear fluid, etc.) and forward them to the reference center in Leuven, in order to determine the capsular serogroups and types (SGTs) and their resistance. RESULTS: From 1994 to 1998, the 5486 S. pneumoniae strains examined belonged to 39 of the 46 currently identified SGTs. The 10 most frequent SGTs accounted for 78.9% of the isolates, and 97% of all isolates belonged to SGTs included in the 23-valent vaccine. Overall mortality of patients with pneumococcal bacteremia or meningitis was 9.7%, and 23.8% in patients over 80 years. From 1994 to 1998, resistance to penicillin (P) increased from 7.6% to 14.2%, to tetracycline (T) from 14.9% to 28.0%, and to erythromycin (E) from 22.9% to 31%. Triple resistance (PTE) increased from 0.9% in 1994 to 6.6% in 1998. Five SGTs (6, 9, 14, 19 and 23) accounted for 50% of the isolates, but for > 90% of the penicillin-resistant or erythromycin-resistant isolates. CONCLUSIONS: Resistance of S. pneumoniae to penicillin, erythromycin and tetracycline is steadily increasing and is concentrated in five serotypes included in the 23-valent pneumococcal vaccine. Increasing resistance and high mortality of invasive infections are an incentive to vaccinate vulnerable groups.

Asunto(s)

Farmacorresistencia Microbiana , Streptococcus pneumoniae/clasificación , Adolescente , Adulto , Bélgica , Niño , Preescolar , Humanos , Lactante , Pruebas de Sensibilidad Microbiana , Persona de Mediana Edad , Infecciones Neumocócicas/mortalidad , Serotipificación , Streptococcus pneumoniae/efectos de los fármacos , Streptococcus pneumoniae/aislamiento & purificación

RESUMEN

BACKGROUND & AIMS: Drug-induced immunoallergic hepatitis typically affects a minority of patients exposed to a particular drug. Its rarity is believed to be due to metabolic or immunologic idiosyncrasy. The presence of an immunologic idiosyncrasy might imply an HLA association. Previous studies reporting an HLA association of drug-induced hepatitis included only small numbers of patients and used serological HLA typing. METHODS: We studied 35 patients with biopsy-documented amoxicillin-clavulanate-induced hepatitis. HLA-A and -B were typed using alloantisera and compared with those of 300 controls (volunteer bone marrow donors). HLA-DRB and -DWB were typed by polymerase chain reaction-line probe assay, with 60 volunteer bone marrow donors serving as controls. RESULTS: The study group was characterized by a higher frequency of DRB1*1501-DRB5*0101-DQB1*0602 haplotype (57.1% vs. 11.7% in controls, P < 0.000005; after correction for the large number of comparisons, P < 0.0002). Patients with DRB1*1501-DRB5*0101-DQB1*0602 haplotype were more likely than patients without it to have a cholestatic (70% vs. 60%) or mixed (30% vs. 13%) than a hepatocellular pattern of hepatitis (0% vs. 27%) (P < 0.05). CONCLUSIONS: Amoxicillin-clavulanate-induced hepatitis is associated with the DRB1*1501-DRB5*0101-DQB1*0602 haplotype. The data support the view that an immunologic idiosyncrasy, mediated through HLA class II antigens, plays a role in the pathogenesis of drug-induced immunoallergic hepatitis. HLA association has a limited impact on the expression of hepatitis.

Asunto(s)

Amoxicilina/efectos adversos , Enfermedad Hepática Inducida por Sustancias y Drogas/inmunología , Ácido Clavulánico/efectos adversos , Antígenos de Histocompatibilidad Clase II/análisis , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Antígenos HLA-DQ/genética , Cadenas beta de HLA-DQ , Antígenos HLA-DR/genética , Cadenas HLA-DRB1 , Cadenas HLA-DRB5 , Haplotipos , Humanos , Masculino , Persona de Mediana Edad

RESUMEN

Efforts to improve the diagnosis of invasive aspergillosis (IA) have been directed towards the detection of fungal antigens, including galactomannan (GM). However, previous evaluations of GM detection have been hampered by a lack of proven cases of IA and by a nonserial study design. This prospective study assessed the diagnostic value of serial screening for circulating GM by using a recently developed sandwich enzyme-linked immunosorbent assay (ELISA) for prolonged-neutropenic and/or steroid-treated patients with hematological disorders. Serum GM levels were monitored twice weekly for 186 consecutive patients at increased risk for IA. The patients were stratified according to the likelihood of IA (proven, probable, possible, and no evidence of IA) by using stringent criteria. Proven IA was defined by characteristic histopathological findings together with a positive culture for Aspergillus species. Autopsy and culture from autopsy specimens was used to verify both positive and negative test results. A total of 2,172 serum samples were tested from 243 episodes (mean, 9 samples/episode). Based on the analysis of 71 patients with confirmed disease status (culture and histology), the sensitivity and specificity of serial GM monitoring were 92.6 and 95.4%, respectively. The positive predictive value was almost 93%, the negative predictive value was 95%, and the efficacy was 94%. False-positive reactions occurred at a rate of nearly 8%, although this figure might have been overestimated. Less than 1% of all tested sera were considered inconclusive. In more than half of the cases, antigenemia was detected before clinical suspicion of IA (median, 6 days before). Serial determination of serum GM by the sandwich ELISA technique is a sensitive tool for the diagnosis of IA in hematological patients at risk. This approach may substantially influence clinical management with regard to preemptive and empirical antifungal therapy.

Asunto(s)

Aspergilosis/diagnóstico , Enfermedades Hematológicas/complicaciones , Mananos/sangre , Adolescente , Adulto , Anciano , Autopsia , Niño , Preescolar , Ensayo de Inmunoadsorción Enzimática , Femenino , Galactosa/análogos & derivados , Humanos , Lactante , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Riesgo

RESUMEN

MICs of 16 non-beta-lactams were determined by agar dilution for 283 penicillin-susceptible, 122 intermediate and 23 fully penicillin-resistant isolates of pneumococci. Penicillin-resistant pneumococci were more likely to be resistant to tetracyclines, macrolides and related compounds. In the latter group, quinupristin/dalfopristin was the only compound whose activity was not influenced by penicillin resistance. Among the fluoroquinolones, clinafloxacin and trovafloxacin showed excellent activity. Strains resistant to macrolides, tetracycline and penicillin were concentrated in serogroups 6, 9, 14, 19 and 23.

Asunto(s)

Antibacterianos/farmacología , Resistencia a las Penicilinas , Streptococcus pneumoniae/efectos de los fármacos , Farmacorresistencia Microbiana , Humanos , Macrólidos , Pruebas de Sensibilidad Microbiana , Penicilinas/farmacología , Infecciones Neumocócicas/microbiología , Streptococcus pneumoniae/aislamiento & purificación , Resistencia a la Tetraciclina

RESUMEN

In 1994 a sudden increase in penicillin resistance was observed in Belgium among invasive pneumococci. To determine whether this increase was due to clonal spread of a resistant strain or to de novo acquisition of penicillin resistance, pneumococci of capsular types 23F, 19, 14, 9, and 6 isolated in 1993 and 1994, were analyzed by capsular serotyping and DNA macrorestriction analysis, resolved by pulsed-field gel electrophoresis. Furthermore, pneumococcal isolates from northern France, a region with a high prevalence of penicillin resistance, and from southern Belgium, a region with a low but increasing prevalence of penicillin resistance, were analyzed. The rate of resistance of invasive pneumococci to penicillin increased from 2.3% in 1993 to 7.6% in 1994. Pneumococcal serotype 23F represented 26.7% of the penicillin-resistant isolates in 1993 and 40.4% in 1994, while the prevalence of serotype 23F decreased from 10.9% in 1993 to 8.8% in 1994. In 1994 up to 35.8% of serotype 23F isolates were penicillin resistant. The Belgian penicillin-resistant 23F isolates from 1994 were genetically closely related to the French 23F penicillin-resistant isolates and, as clones were clearly distinct from the other serotypes as well as from the penicillin-susceptible 23F isolates. These data demonstrate the important contribution of the clonal spread of a penicillin-resistant pneumococcal strain in the overall increase of penicillin resistance in our country.

Asunto(s)

Resistencia a las Penicilinas , Infecciones Neumocócicas/microbiología , Streptococcus pneumoniae/efectos de los fármacos , Streptococcus pneumoniae/genética , Bélgica , ADN Bacteriano/análisis , Electroforesis en Gel de Campo Pulsado , Humanos , Pruebas de Sensibilidad Microbiana , Penicilinas/farmacología , Filogenia , Serotipificación , Streptococcus pneumoniae/clasificación

RESUMEN

While endovascular trophoblast invasion of the human placental bed spiral arteries has been studied extensively, no information is available on the interaction between interstitially invading trophoblast and uterine capillaries and venules. Placental bed biopsies of eight normotensive and 15 pre-eclamptic patients were double-immunostained for cytokeratin and the endothelial marker CD31, providing satisfactory staining results in six and 10 biopsies, respectively. Interstitial trophoblast tissue density did not differ between the two series of biopsies, implying that this pathway of invasion is not impaired in pre-eclampsia. Both groups showed a similar incidence of approach of non-arterial vascular structures by perivascular trophoblast. Differences in CD31 staining intensity were noticed in different vascular cross-sections. Lower staining intensity was related to the presence of perivascular trophoblast. Because of the identity of CD31 with the platelet-endothelial cell adhesion molecule (PECAM)-1, the trophoblast-dependent downregulation of CD31 may play a role in the control of leukocytic traffic within the placental bed. The phenomena described in this paper did not show any difference between the normotensive and pre-eclamptic patients, implying that interaction of interstitial trophoblast with venous and capillary structures is not related to the pathogenesis of pre-eclampsia.

Asunto(s)

Circulación Placentaria/fisiología , Preeclampsia/metabolismo , Embarazo/metabolismo , Trofoblastos/metabolismo , Adulto , Capilares/metabolismo , Endotelio Vascular/metabolismo , Femenino , Edad Gestacional , Humanos , Técnicas para Inmunoenzimas , Queratinas/metabolismo , Placenta/irrigación sanguínea , Molécula-1 de Adhesión Celular Endotelial de Plaqueta/metabolismo , Trofoblastos/citología , Vénulas/metabolismo

RESUMEN

AIM: To compare the performance of leucocyte esterase and nitrite dipstick tests with microscopic examination and culture of first morning urines (n = 420) of hospital inpatients. RESULTS: The sensitivity, specificity, and negative predictive value of the leucocyte esterase test for the cutoff of > 10 WBC/microliter were 57%, 94%, and 68%, respectively. For > 5 WBC per high power field (HPF) these variables were 84%, 90%, and 93%. For > 10(5) colony counts/ml, the sensitivity of the nitrite test was 27%, specificity 94%, and negative predictive value 87%. When either leucocyte esterase or nitrite positivity was accepted as a marker of urinary tract infection, the sensitivity was 78%, specificity 75%, and negative predictive value 94%, and there were 22% false negative results. Semiquantitative microscopic estimation of bacteria per HPF yielded 40% false positives. CONCLUSIONS: Leucocyte esterase and nitrite dipstick tests are not suitable for screening for urinary tract infections.

Asunto(s)

Hidrolasas de Éster Carboxílico/orina , Nitritos/orina , Tiras Reactivas , Infecciones Urinarias/diagnóstico , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Técnicas Bacteriológicas , Biomarcadores/orina , Niño , Preescolar , Femenino , Humanos , Lactante , Recién Nacido , Masculino , Persona de Mediana Edad , Neutrófilos/enzimología , Valor Predictivo de las Pruebas , Sensibilidad y Especificidad , Infecciones Urinarias/microbiología

RESUMEN

Between 1967 and 1996, > 18,700 strains of Yersinia species, excluding Yersinia pestis, were recovered in Belgium from a variety of gastrointestinal and extraintestinal sites in patients. Full identification and serotyping were performed by the two Belgian reference laboratories. Yersinia enterocolitica serogroup O:3 predominated (79.4% of strains), followed by serogroup O:9 (11.1%). The remaining 9.5% of isolates belonged to serogroups and related species generally considered nonpathogenic. Acute enterocolitis was the most common clinical form of Y. enterocolitica infection, affecting primarily children younger than 5 years of age. Since 1967, there was a steady increase in isolations every year, with 305 cases in 1975 and up to 1,469 in 1986. From 1987 on, there was a clear decrease in the number of reported cases, although the number of participating laboratories and culture techniques remained constant. This significant decrease in the occurrence of Y. enterocolitica infections may be explained by changes in the slaughtering procedures and eating habits of the population.

Asunto(s)

Yersiniosis/epidemiología , Yersinia enterocolitica , Adolescente , Adulto , Anciano , Bélgica/epidemiología , Niño , Preescolar , Humanos , Lactante , Persona de Mediana Edad , Serotipificación , Yersinia enterocolitica/clasificación

RESUMEN

MICs of 21 beta-lactams were determined by agar dilution against 283 penicillin-susceptible (pen-S), 122 intermediate (pen-I) and 23 fully penicillin-resistant (pen-R) pneumococci. MICs of all beta-lactams increased with increasing MICs of penicillin. Clometocillin was the most active penicillin against pen-I or pen-R pneumococci. All oral cephalosporins except cefuroxime and cefpodoxime were less active than penicillin and none was satisfactory against pen-I or pen-R pneumococci. The parenteral third- and fourth-generation cephalosporins (except ceftazidime) were similar in activity to penicillin against pen-S isolates. Cefpirome showed the lowest mean MICs against pen-I and pen-R strains.

Asunto(s)

Antibacterianos/farmacología , Resistencia a las Penicilinas , Penicilinas/farmacología , Streptococcus pneumoniae/efectos de los fármacos , beta-Lactamas/farmacología , Amoxicilina/farmacología , Ampicilina/farmacología , Antibacterianos/administración & dosificación , Carbapenémicos/farmacología , Cefaclor/farmacología , Cefadroxilo/farmacología , Cefatrizina/farmacología , Cefepima , Cefixima , Cefotaxima/análogos & derivados , Cefotaxima/farmacología , Ceftazidima/farmacología , Ceftibuteno , Ceftizoxima/análogos & derivados , Ceftizoxima/farmacología , Ceftriaxona/farmacología , Cefuroxima/farmacología , Cefalosporinas/farmacología , Cefradina/farmacología , Farmacorresistencia Microbiana , Resistencia a Múltiples Medicamentos , Humanos , Pruebas de Sensibilidad Microbiana , Piperacilina/farmacología , Infecciones Neumocócicas/microbiología , Serotipificación , Especificidad de la Especie , Streptococcus pneumoniae/clasificación , beta-Lactamas/administración & dosificación , Cefpiroma , Cefpodoxima

RESUMEN

Between 1991 and 1995 the Belgian National Program for Surveillance of Hospital Infections (NSIH) collected data on perioperative antibiotic prophylaxis in 72 acute care hospitals. From the costs of prophylactic antibiotics for six categories of surgical procedure and from discharge summaries for hospitalization episodes nationwide, annual drug costs were estimated for 73% of Belgian surgical activity. Costs of antibiotics used in these surgical activities were estimated at 386-410 million Belgian francs (Bf) per year (US$12.1-12.9 million). After agreeing recommendations for best practice, the hypothetical costs of 'optimal' antimicrobial prophylaxis were calculated for the same selection of surgical procedures. It was calculated that savings of at least 194 million Bf (US$6.1 million) could be made if recommendations were followed closely. Only the costs borne by the National Health Insurance Institute for reimbursement of the dispensed drugs were considered in this study. Other direct costs, such as those related to drug storage, dispensing and administration, were not included.

Asunto(s)

Profilaxis Antibiótica/economía , Procedimientos Quirúrgicos Operativos/estadística & datos numéricos , Antibacterianos/economía , Bélgica , Análisis Costo-Beneficio , Guías como Asunto , Hospitales , Humanos , Procedimientos Quirúrgicos Operativos/clasificación

RESUMEN

During a 6-month period, all clinical isolates of catalase-positive coryneform organisms, which were isolated during the routine processing of clinical specimens, were characterized in the laboratory of the 1800-bed University Hospital of Leuven. The distribution of the species in the corynebacteria was: Corynebacterium amycolatum 70 (53%), Corynebacterium jeikeium 16 (12%), Corynebacterium striatum 11 (8%), Corynebacterium afermentans 10 (7%), Corynebacterium minutissimum 9 (6%), CDC coryneform group G 4 (3%), Corynebacterium urealyticum 4 (3%), Corynebacterium glucuronolyticum 1 (0.7%), and Corynebacterium xerosis 1 (0.7%). Of the 150 isolates, 37 (25%) were considered to be infection related and the remaining 113 (75%) were of questionable clinical significance. Susceptibility of the corynebacteria to 12 antibiotics active against Gram-positive organisms was evaluated. C. amycolatum, C. jeikeium, and C. urealyticum were multiresistant, but all isolates were susceptible to teicoplanin and vancomycin. Most of the C. amycolatum strains, and all strains of C. jeikeium and C. striatum, were susceptible to the vibrocidal compound O/129.

Asunto(s)

Actinomycetales/aislamiento & purificación , Antibacterianos/farmacología , Infecciones por Corynebacterium/microbiología , Corynebacterium/aislamiento & purificación , Actinomycetales/clasificación , Actinomycetales/efectos de los fármacos , Actinomycetales/patogenicidad , Bélgica , Corynebacterium/clasificación , Corynebacterium/efectos de los fármacos , Corynebacterium/patogenicidad , Infección Hospitalaria/microbiología , Farmacorresistencia Microbiana , Resistencia a Múltiples Medicamentos , Humanos , Pruebas de Sensibilidad Microbiana , Estudios Prospectivos