Hospital General Universitario Gregorio Marañón

About: Hospital General Universitario Gregorio Marañón is a healthcare organization based out in Madrid, Spain. It is known for research contribution in the topics: Population & Transplantation. The organization has 11975 authors who have published 12386 publications receiving 244847 citations.

Metronidazole Resistance in Clostridium difficile Is Heterogeneous

Abstract: At our institution, the prevalence of clinical isolates of Clostridium difficile with resistance to metronidazole is 6.3%. We observed that initial metronidazole MICs of 16 to 64 mg/liter against toxigenic, primary fresh C. difficile isolates, as determined by agar dilution, decreased to 0.125 mg/liter after the isolates were thawed. In this study, we examined the possibility of heterogeneous or inducible resistance. Totals of 14 metronidazole-resistant and 10 metronidazole-susceptible clinical isolates of toxigenic C. difficile were studied. The isolates were investigated for the presence of nim genes by PCR. After the isolates were thawed, susceptibility testing was done by agar dilution, by disc diffusion using a 5-μg metronidazole disc, and by the Etest method. An experiment for determining the effect of prolonged exposure to metronidazole was applied to all resistant isolates and to susceptible control strains. None of the isolates presented the nim genes. All initially metronidazole-resistant C. difficile isolates became susceptible after thawing; however, they presented slow-growing subpopulations within the inhibition zones of both the disk and the Etest strip. All metronidazole-susceptible isolates remained homogeneously susceptible by both methods. After prolonged exposure in vitro to metronidazole, no zone of inhibition was found around the 5-μg disk in any of the metronidazole-resistant isolates, and the MICs as determined by the Etest method ranged from 0.125 to >256 mg/liter, with colonies growing inside the inhibition zone. Our results indicate that (i) resistance to metronidazole was not due to the presence of nim genes, (ii) resistance to metronidazole in toxigenic C. difficile isolates is heterogeneous, and (iii) prolonged exposure to metronidazole can select for in vitro resistance. We recommend routine performance of the disk diffusion method (5-μg metronidazole disk) with primary fresh C. difficile isolates in order to ensure that metronidazole-heteroresistant populations do not go undetected.

A conservative procedure for the diagnosis of catheter-related infections.

Abstract: A prospective study was done in 139 intravascular catheters (IVCs) that had been removed for different reasons. The purpose of the study was to compare laboratory procedures for the diagnosis of catheter-related infections and also to attempt to clarify the present controversy regarding the portal of entry of such infections. The IVCs were removed by one of us and multiple samples were studied according to a standard procedure. Semi-quantitative cultures were performed of the tips, the interior of the hub, and the skin around the insertion point. Quantitative cultures were performed of the infusion fluid and of the IVC tips. Of the 139 IVCs studied, 53 (38.1%) were infected (greater than or equal to 15 colony-forming units per plate in the semiquantitative culture). Semi-quantitative and quantitative cultures gave comparable results, but the semiquantitative procedure proved to be easier and faster. All but three infected catheters had a positive (greater than or equal to 15 colony-forming units per plate) skin and/or hub culture (superficial cultures), with microorganisms identical to those isolated in the IVC tip. Our results showed two possible and differentiable portals of entry. Thirty (56.6%) had external origin (semiquantitative skin culture positive), 12 (22.6%) had an internal origin (semiquantitative hub culture positive), and 8 (15.1%) had both origins. All catheters with negative superficial cultures had a negative tip. The predictive value of positive superficial cultures in the diagnosis of catheter-related infection was 66.2% and that of negative cultures was 96.7%. In patients with suspected catheter-related infections but negative superficial cultures, the possibility of infection may reasonably be ruled out, thereby avoiding many unnecessary catheter withdrawals.

Validación española del cuestionario Brief Pain Inventory en pacientes con dolor de causa neoplásica

Abstract: Fundamento y objetivo Validar la version espanola del cuestionario Brief Pain Inventory (BPI)para medir la intensidad del dolor de causa neoplasica y su impacto en las actividades de lavida diaria en pacientes con cancer. Pacientes y metodo Se incluyo consecutivamente a pacientes con dolor de origen neoplasico. Lospacientes cumplimentaron los cuestionarios BPI (Cuestionario Breve del Dolor o CBD en espanol)y el Rotterdam Symptom Checklist (RSCL) en la visita de inclusion. El CBD se repitio a los3-5 dias en los pacientes clinicamente estables de su dolor de origen neoplasico y ambos cuestionariosse repitieron al mes en los pacientes no estables de su dolor. Resultados Se evaluo a 126 pacientes, el 85,1% habia sufrido algun episodio de dolor irruptivoen las 24 h previas al inicio del estudio. El 86,5% de los pacientes completo el CBD en sutotalidad. Las puntuaciones del CBD se correlacionaron con la percepcion del paciente de laintensidad maxima del dolor y con la presencia de tumor diseminado. La dimension «sintomaspsicologicos» del RSCL fue la que presento mayor correlacion con las dimensiones del CBD(«intensidad del dolor» e «interferencia en las actividades»). La consistencia interna de las dimensionesfue buena (0,87 y 0,89), y la fiabilidad test-retest entre baja y moderada (0,53 y0,77). El CBD ha demostrado ser un instrumento capaz de detectar cambios en el nivel de dolor.Los cambios observados en las dos dimensiones del CBD entre las dos visitas de estudio reflejanlos cambios percibidos por el propio paciente en la intensidad del dolor. Conclusiones La version espanola del CBD se mostro valida para medir la intensidad del dolorde causa neoplasica y su impacto en las actividades de la vida diaria, en condiciones de practicaclinica habitual.