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Piscirickettsiosis is the main cause of mortality in salmonids of commercial importance in Chile, which is caused by Piscirickettsia salmonis, a Gram-negative, γ-proteobacteria that can produce biofilm as one of its virulence factors. The Chilean salmon industry uses large amounts of antibiotics to control piscirickettsiosis outbreaks, which has raised concern about its environmental impact and the potential to induce antibiotic resistance. Thus, the use of phytogenic feed additives (PFA) with antibacterial activity emerges as an interesting alternative to antimicrobials. Our study describes the antimicrobial action of an Andrographis paniculate-extracted PFA on P. salmonis planktonic growth and biofilm formation. We observed complete inhibition of planktonic and biofilm growth with 500 and 400 µg/mL of PFA for P. salmonis LF-89 and EM-90-like strains, respectively. Furthermore, 500 µg/mL of PFA was bactericidal for both evaluated bacterial strains. Sub-inhibitory doses of PFA increase the transcript levels of stress (groEL), biofilm (pslD), and efflux pump (acrB) genes for both P. salmonis strains in planktonic and sessile conditions. In conclusion, our results demonstrate the antibacterial effect of PFA against P. salmonis in vitro, highlighting the potential of PFA as an alternative to control Piscirickettsiosis.

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Background: Citrobacter koseri, a Gram-negative organism, rarely causes an epidural spinal abscess. Case Description: A 50-year-old male presented with mild paraparesis attributed to an magnetic resonance (MR)-documented spinal epidural abscess (SEA) at the T10-level. Following surgical debridement, cultures grew C. koseri, a rare Gram-negative organism. The abscess was subsequently managed with a prolonged course of antibiotics resulting in complete symptom and MR-documented radiological resolution. Conclusion: A 50-year-old male presented with a T10 SEA attributed to a rare Gram-negative organism, C. koseri. The abscess was appropriately managed with surgical decompression/debridement, followed by prolonged antibiotic therapy.

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RATIONALE & OBJECTIVE: Infections are an important cause of mortality among patients receiving maintenance hemodialysis. Staphylococcus aureus is a frequent etiological agent, and previous nasal colonization is a risk factor for infection. Repeated antimicrobial decolonization reduces infection in this population but can induce antibiotic resistance. We compared photodynamic therapy, a promising bactericidal treatment that does not induce resistance, to mupirocin treatment among nasal carriers of S aureus. STUDY DESIGN: Randomized controlled pilot study. SETTING & PARTICIPANTS: 34 patients receiving maintenance hemodialysis who had nasal carriage of S aureus. INTERVENTIONS: Patients were randomly assigned to decolonization with a single application of photodynamic therapy (wavelength of 660nm, 400mW/cm2, 300 seconds, methylene blue 0.01%) or with a topical mupirocin regimen (twice a day for 5 days). OUTCOME: Nasal swabs were collected at time 0 (when the carrier state was identified), directly after treatment completion, 1 month after treatment, and 3 months after treatment. Bacterial isolates were subjected to proteomic analysis to identify the species present, and antimicrobial susceptibility was characterized. RESULTS: All 17 participants randomized to photodynamic therapy and 13 of 17 (77%) randomized to mupirocin were adherent to treatment. Directly after treatment was completed, 12 participants receiving photodynamic therapy (71%) and 13 participants treated with mupirocin (77%) had cultures that were negative for S aureus (risk ratio, 0.92 [95% CI, 0.61-1.38]; P=0.9). Of the patients who had negative cultures directly after completion of photodynamic therapy, 67% were recolonized within 3 months. There were no adverse events in the photodynamic therapy group. LIMITATIONS: Testing was restricted to assessing nasal colonization; infectious complications were not assessed. CONCLUSIONS: Photodynamic therapy is a feasible approach to treating nasal carriage of S aureus. Future larger studies should be conducted to determine whether photodynamic therapy is equivalent to the standard of care with mupirocin. FUNDING: Government grant (National Council for Scientific and Technological Development process 3146682020-9). TRIAL REGISTRATION: Registered at ClinicalTrials.gov with study number NCT04047914.

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Tenacibaculosis caused by Tenacibaculum dicentrarchi is the third most important bacterial fish infection affecting the Chilean salmon industry. Losses to this disease are most frequently controlled by treatments with florfenicol and oxytetracycline. However, recent tenacibaculosis outbreaks were controlled through the extra-label, oral administration of tiamulin, resulting in high treatment efficiency. In this study, we present an analysis of susceptibility patterns of 32 T. dicentrarchi isolates and the type strain CECT 7612T to tiamulin by determining the minimum inhibitory concentrations (MICs) according to the procedures recommended by the Clinical and Laboratory Standard Institute, but fixing incubation temperature to the more appropriate for the growth of T. dicentrarchi (18 ºC). The MICs of the T. dicentrarchi isolates were unimodally distributed (0.06-1.0 µg/ml range), while the CECT 7612T strain presented an MIC of 0.5 µg/ml. Calculations using Normalized Resistance Interpretation provided epidemiological cut-off values of ≤1.0 µg/ml, with the 33 T. dicentrarchi classified as wild type. In Chile, tiamulin is authorized for use in other livestock species, but application in salmonids is extra-label. Our presented in vitro results suggest that tiamulin is a viable alternative to florfenicol, specifically as tiamulin requires comparatively lower concentrations to inhibit T. dicentrarchi. Considering that tiamulin is also exclusively for veterinary use, is classified as "least important" by the World Health Organization and has not resulted in the development of bacterial resistance, pharmaceutical companies should be requested to register tiamulin and provide alternative antimicrobial treatments for the salmonid industry.

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In the present research work, we propose a new antimicrobial treatment for pyoderma via cutaneous permeation of bacteriophage particles conveyed in a hydroxyethylcellulose (HEC) gel integrating ionic liquid as a permeation enhancer. Ionic liquids are highly viscous fluids constituted exclusively by ions, that are usually hydrolytically stable and promote solubilization of amphipathic molecules such as proteins, hence serving as green solvents and promoting the transdermal permeation of biomolecules. In the research effort entertained herein, the synthesis and use of choline geranate for integrating a HEC gel aiming at the structural and functional stabilization of a cocktail of isolated lytic bacteriophage particles was sought, aiming at transdermal permeation in the antimicrobial treatment of animal pyoderma. The results obtained showed a high ability of the ionic liquid in enhancing transdermal permeation of the bacteriophage particles, with concomitant high potential of the HEC gel formulation in the antimicrobial treatment of animal skin infections.

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Enterobacter cloacae complex has been increasingly recognized as a nosocomial pathogen representing the third major Enterobacteriaceae species involved with infections. This study aims to evaluate virulence and antimicrobial susceptibility of subpopulations generated from macrocolonies of NDM-1 producing Enterobacter hormaechei clinical isolates. Biofilm was quantified using crystal violet method and fimbrial genes were investigated by PCR. Susceptibility of antimicrobials, alone and combined, was determined by minimum inhibitory concentration and checkerboard assays, respectively. Virulence and efficacy of antimicrobials were evaluated in Galleria mellonella larvae. Importantly, we verified that some subpopulations that originate from the same macrocolony present different biofilm production ability and distinct susceptibility to meropenem due to the loss of blaNDM-1 encoding plasmid. A more in-depth study was performed with the 798 macrocolony subpopulations. Type 3 fimbriae were straightly related with biofilm production; however, virulence in larvae was not statistically different among subpopulations. Triple combination with meropenem-rifampicin-polymyxin B showed in vitro synergistic effect against all subpopulations; while in vivo this treatment showed different efficacy rates for 798-1S and 798-4S subpopulations. The ability of multidrug resistant E. hormaechei isolates in generating bacterial subpopulations presenting different susceptible and virulence mechanisms are worrisome and may explain why these infections are hardly overcome.

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Coagulase-negative Staphylococcus spp. (CNS) are the main microorganisms involved in ovine mastitis. Treatment at the end of lactation can contribute towards cure and prevention of subclinical cases during the subsequent lactation. However, virulence factors and resistance mechanisms presented by CNS can decrease cure rates. The aims of the study were to identify the species of CNS in milk of mastitic ewes with and without antimicrobial treatment, and to investigate the presence of genes relating to resistance of β-lactam antimicrobials, formation of biofilms, production of enterotoxins and production of the toxic shock syndrome toxin. Cases of failure in the treatment were related with the presence/absence of the respective genes. Sixty sheep were divided into three groups: G1, without treatment; G2, animals treated via the intramammary route with 100mg of cloxacillin during drying off; and G3, sheep treated via the intramammary route with 50 mg of nanoparticulate cloxacillin. Milk samples were gathered during drying off and 15 and 30 days after the parturition of the subsequent lactation. The analyses to identify the species of CNS were carried out by means of the internal transcribe spacer technique and the investigation of the genes responsible for the virulence factors and resistance to oxacillin was performed using the polymerase chain reaction (PCR) technique. No sample was positive for the mecA gene. The only gene relating to production of enterotoxins was sec. Among the genes relating to production of biofilm, icaD was the only one identified in the three experimental groups. Staphylococcus warneri was the main species of CNS isolated during the pre and post-partum periods of the sheep. The species carrying genes relating to production of enterotoxins and biofilms were present in uncured sheep.(AU)

Staphylococus spp. coagulase-negativos (SCN) estão entre os principais micro-organismos envolvidos na mastite ovina. O tratamento ao final da lactação pode contribuir com a cura e a prevenção de casos subclínicos durante a lactação seguinte. Todavia, fatores de virulência e mecanismos de resistência apresentados por SCN podem reduzir as taxas de cura. Os objetivos desse estudo foram identificar as espécies de SCN no leite de ovelhas com mastite com e sem tratamento antimicrobiano e investigar a presença de genes relacionados com resistência a antibióticos beta lactâmicos, formação de biofilmes, produção de enterotoxinas e produção da toxina da síndrome do choque tóxico. Casos de falhas no tratamento foram relacionados com a presença/ausência dos respectivos genes. Sessenta ovelhas foram divididas em três grupos: G1, sem tratamento; G2, animais tratados via intramamária com 100mg de cloxacilina antes da secagem; e G3, ovelhas tratadas via intramamária com 50 mg de cloxacilina nanoparticulada. Amostras de leite foram obtidas durante a secagem e 15 e 30 dias depois do parto na lactação seguinte. As análises para identificar as espécies de SCN foram conduzidas por meio da técnica de Internal transcribe spacer e a investigação dos genes responsáveis pelos fatores de virulência e resistência à oxacilina foi realizada usando a técnica reação em cadeia da polimerase. Nenhuma amostra foi positiva para o gene mecA. O único gene relacionado com a produção de enterotoxinas foi o sec. Dentre os genes relacionados com a produção de biofilme, icaD foi o único identificado nos três grupos experimentais. Staphylococcus warneri foi a principal espécie de SCN isolada durante o pré e pós-parto. As espécies que apresentaram genes relacionados com a produção de enterotoxinas e biofilmes estavam presentes nas ovelhas não curadas.(AU)

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Coagulase-negative Staphylococcus spp. (CNS) are the main microorganisms involved in ovine mastitis. Treatment at the end of lactation can contribute towards cure and prevention of subclinical cases during the subsequent lactation. However, virulence factors and resistance mechanisms presented by CNS can decrease cure rates. The aims of the study were to identify the species of CNS in milk of mastitic ewes with and without antimicrobial treatment, and to investigate the presence of genes relating to resistance of β-lactam antimicrobials, formation of biofilms, production of enterotoxins and production of the toxic shock syndrome toxin. Cases of failure in the treatment were related with the presence/absence of the respective genes. Sixty sheep were divided into three groups: G1, without treatment; G2, animals treated via the intramammary route with 100mg of cloxacillin during drying off; and G3, sheep treated via the intramammary route with 50 mg of nanoparticulate cloxacillin. Milk samples were gathered during drying off and 15 and 30 days after the parturition of the subsequent lactation. The analyses to identify the species of CNS were carried out by means of the internal transcribe spacer technique and the investigation of the genes responsible for the virulence factors and resistance to oxacillin was performed using the polymerase chain reaction (PCR) technique. No sample was positive for the mecA gene. The only gene relating to production of enterotoxins was sec. Among the genes relating to production of biofilm, icaD was the only one identified in the three experimental groups. Staphylococcus warneri was the main species of CNS isolated during the pre and post-partum periods of the sheep. The species carrying genes relating to production of enterotoxins and biofilms were present in uncured sheep.(AU)

Staphylococus spp. coagulase-negativos (SCN) estão entre os principais micro-organismos envolvidos na mastite ovina. O tratamento ao final da lactação pode contribuir com a cura e a prevenção de casos subclínicos durante a lactação seguinte. Todavia, fatores de virulência e mecanismos de resistência apresentados por SCN podem reduzir as taxas de cura. Os objetivos desse estudo foram identificar as espécies de SCN no leite de ovelhas com mastite com e sem tratamento antimicrobiano e investigar a presença de genes relacionados com resistência a antibióticos beta lactâmicos, formação de biofilmes, produção de enterotoxinas e produção da toxina da síndrome do choque tóxico. Casos de falhas no tratamento foram relacionados com a presença/ausência dos respectivos genes. Sessenta ovelhas foram divididas em três grupos: G1, sem tratamento; G2, animais tratados via intramamária com 100mg de cloxacilina antes da secagem; e G3, ovelhas tratadas via intramamária com 50 mg de cloxacilina nanoparticulada. Amostras de leite foram obtidas durante a secagem e 15 e 30 dias depois do parto na lactação seguinte. As análises para identificar as espécies de SCN foram conduzidas por meio da técnica de Internal transcribe spacer e a investigação dos genes responsáveis pelos fatores de virulência e resistência à oxacilina foi realizada usando a técnica reação em cadeia da polimerase. Nenhuma amostra foi positiva para o gene mecA. O único gene relacionado com a produção de enterotoxinas foi o sec. Dentre os genes relacionados com a produção de biofilme, icaD foi o único identificado nos três grupos experimentais. Staphylococcus warneri foi a principal espécie de SCN isolada durante o pré e pós-parto. As espécies que apresentaram genes relacionados com a produção de enterotoxinas e biofilmes estavam presentes nas ovelhas não curadas.(AU)

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ABSTRACT: Coagulase-negative Staphylococcus spp. (CNS) are the main microorganisms involved in ovine mastitis. Treatment at the end of lactation can contribute towards cure and prevention of subclinical cases during the subsequent lactation. However, virulence factors and resistance mechanisms presented by CNS can decrease cure rates. The aims of the study were to identify the species of CNS in milk of mastitic ewes with and without antimicrobial treatment, and to investigate the presence of genes relating to resistance of -lactam antimicrobials, formation of biofilms, production of enterotoxins and production of the toxic shock syndrome toxin. Cases of failure in the treatment were related with the presence/absence of the respective genes. Sixty sheep were divided into three groups: G1, without treatment; G2, animals treated via the intramammary route with 100mg of cloxacillin during drying off; and G3, sheep treated via the intramammary route with 50 mg of nanoparticulate cloxacillin. Milk samples were gathered during drying off and 15 and 30 days after the parturition of the subsequent lactation. The analyses to identify the species of CNS were carried out by means of the internal transcribe spacer technique and the investigation of the genes responsible for the virulence factors and resistance to oxacillin was performed using the polymerase chain reaction (PCR) technique. No sample was positive for the mecA gene. The only gene relating to production of enterotoxins was sec. Among the genes relating to production of biofilm, icaD was the only one identified in the three experimental groups. Staphylococcus warneri was the main species of CNS isolated during the pre and post-partum periods of the sheep. The species carrying genes relating to production of enterotoxins and biofilms were present in uncured sheep.

RESUMO: Staphylococus spp. coagulase-negativos (SCN) estão entre os principais micro-organismos envolvidos na mastite ovina. O tratamento ao final da lactação pode contribuir com a cura e a prevenção de casos subclínicos durante a lactação seguinte. Todavia, fatores de virulência e mecanismos de resistência apresentados por SCN podem reduzir as taxas de cura. Os objetivos desse estudo foram identificar as espécies de SCN no leite de ovelhas com mastite com e sem tratamento antimicrobiano e investigar a presença de genes relacionados com resistência a antibióticos beta lactâmicos, formação de biofilmes, produção de enterotoxinas e produção da toxina da síndrome do choque tóxico. Casos de falhas no tratamento foram relacionados com a presença/ausência dos respectivos genes. Sessenta ovelhas foram divididas em três grupos: G1, sem tratamento; G2, animais tratados via intramamária com 100mg de cloxacilina antes da secagem; e G3, ovelhas tratadas via intramamária com 50 mg de cloxacilina nanoparticulada. Amostras de leite foram obtidas durante a secagem e 15 e 30 dias depois do parto na lactação seguinte. As análises para identificar as espécies de SCN foram conduzidas por meio da técnica de Internal transcribe spacer e a investigação dos genes responsáveis pelos fatores de virulência e resistência à oxacilina foi realizada usando a técnica reação em cadeia da polimerase. Nenhuma amostra foi positiva para o gene mecA. O único gene relacionado com a produção de enterotoxinas foi o sec. Dentre os genes relacionados com a produção de biofilme, icaD foi o único identificado nos três grupos experimentais. Staphylococcus warneri foi a principal espécie de SCN isolada durante o pré e pós-parto. As espécies que apresentaram genes relacionados com a produção de enterotoxinas e biofilmes estavam presentes nas ovelhas não curadas.

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This study aimed to determine whether prepartum antimicrobial and/or Escherichia coli J5 vaccination in dairy heifers influence the milk production, milk quality, and estimate their economic benefit. Thus, 33 dairy heifers were enrolled in four groups using a split-splot design. Groups were: (G1) prepartum antimicrobial infusion and vaccination with an E. coli J5 bacterin, (G2) prepartum antimicrobial infusion, (G3) vaccination with an E. coli J5 bacterin, and (G4) control heifers. Composite milk samples for somatic cell count, total bacteria count and milk composition were collected 15 days after calving and every 15 days until the end of the experiment. Bacteriological analysis was carried out at the end of study. The milk production and the incidence of clinical cases of mastitis, as well as the costs associated with them were recorded. The results demonstrate a reduction on clinical mastitis rates by preventive strategies, which implicated in lower volume of discarded milk (0.99, 1.01, 1.04 and 3.98% for G1, G2, G3 and G4, respectively) and higher economic benefit. Thus, in well-managed dairy herds the prevention of heifer mastitis by vaccination or antimicrobial therapy can reduce the amount of antimicrobials needed to treat clinical mastitis cases and the days of discarded milk.(AU)

O presente estudo objetivou realizar uma análise econômica do tratamento antimicrobiano no pré-parto e/ou da vacinação com Escherihia coli J5 em novilhas leiteiras, e seu efeito sobre a produção e qualidade de leite. Portanto, utilizou-se o delineamento split-splot em esquema fatorial, no qual 33 novilhas da raça Holandesa foram divididas aleatoriamente em quatro grupos: (G1) antimicroianoterapia no pré-parto e vacinação com E. coli J5, (G2) antimicrobianoterapia no pré-parto, (G3) vacinação com E. coli J5 e (G4) controle. Amostras compostas de leite foram coletadas para contagem de células somáticas, contagem bacteriana total e composição do leite 15 dias após o parto, e a cada 15 dias até o término do experimento. A análise bacteriológica do leite foi realizada ao término do experimento. A produção de leite e a incidência dos casos clínicos de mastite, assim como, os custos associados à antimicrobianoterapia no pré-parto e/ou vacinação com E. coli J5 foram registrados. Os resultados demonstraram redução dos casos clínicos de mastite com a implementação das medidas preventivas resultando no menor volume de leite descartado (0,99, 1,01, 1,04 e 3,98% para os animais dos grupos G1, G2, G3 e G4, respectivemente) e maior benefício econômico. Desta forma, em rebanhos bem manejados, a implementação da antimicrobianoterapia no pré-parto e vacinação com E. coli J5 e novilhas pode reduzir a quantidade de antimicrobianos necessário para o tratamento de casos de mastite clínica durante a lactação, resultando em menor número de dias em que o leite é descartado.(AU)

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This study aimed to determine whether prepartum antimicrobial and/or Escherichia coli J5 vaccination in dairy heifers influence the milk production, milk quality, and estimate their economic benefit. Thus, 33 dairy heifers were enrolled in four groups using a split-splot design. Groups were: (G1) prepartum antimicrobial infusion and vaccination with an E. coli J5 bacterin, (G2) prepartum antimicrobial infusion, (G3) vaccination with an E. coli J5 bacterin, and (G4) control heifers. Composite milk samples for somatic cell count, total bacteria count and milk composition were collected 15 days after calving and every 15 days until the end of the experiment. Bacteriological analysis was carried out at the end of study. The milk production and the incidence of clinical cases of mastitis, as well as the costs associated with them were recorded. The results demonstrate a reduction on clinical mastitis rates by preventive strategies, which implicated in lower volume of discarded milk (0.99, 1.01, 1.04 and 3.98% for G1, G2, G3 and G4, respectively) and higher economic benefit. Thus, in well-managed dairy herds the prevention of heifer mastitis by vaccination or antimicrobial therapy can reduce the amount of antimicrobials needed to treat clinical mastitis cases and the days of discarded milk.

O presente estudo objetivou realizar uma análise econômica do tratamento antimicrobiano no pré-parto e/ou da vacinação com Escherihia coli J5 em novilhas leiteiras, e seu efeito sobre a produção e qualidade de leite. Portanto, utilizou-se o delineamento split-splot em esquema fatorial, no qual 33 novilhas da raça Holandesa foram divididas aleatoriamente em quatro grupos: (G1) antimicroianoterapia no pré-parto e vacinação com E. coli J5, (G2) antimicrobianoterapia no pré-parto, (G3) vacinação com E. coli J5 e (G4) controle. Amostras compostas de leite foram coletadas para contagem de células somáticas, contagem bacteriana total e composição do leite 15 dias após o parto, e a cada 15 dias até o término do experimento. A análise bacteriológica do leite foi realizada ao término do experimento. A produção de leite e a incidência dos casos clínicos de mastite, assim como, os custos associados à antimicrobianoterapia no pré-parto e/ou vacinação com E. coli J5 foram registrados. Os resultados demonstraram redução dos casos clínicos de mastite com a implementação das medidas preventivas resultando no menor volume de leite descartado (0,99, 1,01, 1,04 e 3,98% para os animais dos grupos G1, G2, G3 e G4, respectivemente) e maior benefício econômico. Desta forma, em rebanhos bem manejados, a implementação da antimicrobianoterapia no pré-parto e vacinação com E. coli J5 e novilhas pode reduzir a quantidade de antimicrobianos necessário para o tratamento de casos de mastite clínica durante a lactação, resultando em menor número de dias em que o leite é descartado.

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Introducción: el uso inadecuado de los antimicrobianos ha traído un incremento de la resistencia de los microorganismos, aumento de los costos hospitalarios y calidad deficiente en los servicios brindados. Objetivo: orientar una política terapéutica racional de los antimicrobianos sobre todo cuando son utilizados de forma empírica. Fuente de datos: revisión bibliográfica realizada entre 2000-2014 en las bases de datos MedLine, Hinari, Cochrane, PubMed, de revistas líderes en la publicación de artículos de interés. Las palabras claves fueron: antibióticos, resistencia bacteriana, tratamiento antimicrobiano. Se consultaron estudios de cohorte prospectivos, retrospectivos, clínicos, epidemiológicos, revisiones bibliográficas y ensayos clínicos. Síntesis de los datos: aportamos información que puede ser útil en la práctica médica y procederes y métodos creados por diferentes equipos de especialistas en el tema y de consensos internacionales. Siempre que sea posible, debe tenerse en cuenta la toma de un exudado para cultivo y antibiograma que muestre los posibles antimicrobianos a los que el germen es sensible y seleccionar el apropiado según su efectividad con el espectro más estrecho posible, menos efectos indeseables y el más económico para utilizarlo en la dosis adecuada y durante el tiempo necesario según el peso, la talla, la edad y afecciones renales o hepáticas del paciente, para ajuste de las dosis; además, aplicarlo por la vía de administración más sencilla y menos riesgosa, para alcanzar el efecto terapéutico durante el tiempo más corto posible. Conclusiones: se sugiere una terapia antimicrobiana racional y prudente, sobre todo cuando es utilizada de forma empírica. Su efecto es elevar la eficacia de los fármacos empleados en pacientes con afecciones infecciosas frecuentes en angiología(AU)

Introduction: inadequate use of the antimicrobial drugs has brought about increase microorganism resistance, the rise of hospital costs and poor quality of the rendered services. Objective: to advise on the rational therapeutic policy for the use of antimicrobials, mainly when used empirically. Data source: literature review conducted from 2000 to 2014 MedLine, Hinari, Cochrane PubMed databases and in leading journals that publish articles of interest. The following keywords were used: antibiotics, bacterial resistance and antimicrobial treatment. Prospective, retrospective, clinical, epidemiological cohort studies as well as literature reviews and clinical assays were all consulted. Data synthesis: this paper provided some useful information in medical practice, as well as some procedures and methods created by teams of experts on this topic and international consensus on the theme. One must take into account whenever possible exudates for culturing and antibiogram that show the likely antimicrobials to which the microorganism is sensitive, and select the most appropriate based on its narrowest spectrum effectiveness, less adverse effects and the most economic to be used at the right dosage and for the required time depending on weight, size, age and renal or liver conditions of the patient. Additionally, the antimicrobial should be applied through the simplest and less risky way of administration in order to achieve the best results of treatment at the shortest term. Conclusions: It is suggested that rational and prudent antimicrobial therapy should be used in patients, mainly if it is empirically applied. Its effect is to increase efficacy of drugs for patients suffering frequent vascular infections(AU)

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Objective: To describe the feasibility, effectiveness and safety of intravenous (iv) outpatient treatment in 2 to 24 month-old children with febrile urinary tract infection (UTI). Method: Children presenting to the ER, between April 2003-2005, with fever and no identifiable focus who had a diagnosis of UTI were randomized to receive iv antibiotic in the hospital or in an outpatient facility. Children were started on amikacin or ceftriaxona according to physician criteria followed by antimicrobial adjustment based on uriñe culture result and a later switch to an oral antimicrobial. Uriñe cultures were performed during and after completing the antimicrobial course. Adherence and effectiveness of antimicrobial treatment and treatment-associated complications were analyzed. Results: The study included 112 patients, 58 inpatient children and 54 outpatient children, with an average age of 7.7 months. Duration of iv treatment didnot differ among groups (2.8 days (SD 1.2) 2.7 +0.91 days ininpatients vs 2.9 + 1.9 days in outpatients (p = 0.22). In 100 percent of outpatient children and 100 percent of inpatient children (overall 101/101) uriñe cultures were negative on day 5. None of the children had a treatment-associated complication. Cost analysis yielded 73 percent of saving money (overall cost for inpatient treatment US 9,815 vs outpatient treatment US 2,650). Conclusions: Outpatient iv treatment in patients between 2 and 24 months with UTI and fever was effective, safe and of lower cost.

Objetivo: Describir la factibilidad, efectividad y seguridad del tratamiento intravenoso (iv) ambulatorio en niños de 2 meses a 2 años con infección del tracto urinario (ITU) y fiebre. Método: Entre abril 2003 y abril 2005 se realizó un estudio prospectivo en pacientes con fiebre sin foco derivados de Emergencia Infantil, finalmente diagnosticados como ITU, estableciéndose dos grupos con tratamiento iv: uno hospitalizado y otro ambulatorio. Se administró amikacina o ceftriaxona según criterio del médico de turno, hasta obtener resultado del urocultivo, y posteriormente se cambió a tratamiento oral. Se controló urocultivo intra y post tratamiento registrándose adherencia, efectividad y complicaciones. Resultados: Se incluyeron 112 pacientes (58 hospitalizados y 54 ambulatorios), con edad promedio de 7,8 meses. El promedio de días de tratamiento iv fue 2,8 días (SD 1,2) sin diferencias significativas entre ambos grupos 2,7 +0,91 días en los internados vs 2,9 + 1,9 días en los ambulatorios (p = 0,22). En 100 por ciento de ambos grupos de pacientes (en globo 101/101) el urocultivo obtenido al día 5 fue estéril. No hubo complicaciones del tratamiento o sobre la vía venosa. El análisis de costos concluyó que en globo, el manejo ambulatorio representó un 73 por ciento de ahorro económico (1.430.000 pesos chilenos vs 5.300.000 pesos en el sólo rubro de día-cama Conclusiones: El tratamiento iv ambulatorio en pacientes con ITU febril entre 2 y 24 meses fue efectivo, seguro y a un menor costo.

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