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C Pigrau

Publications and source records attributed to C Pigrau.

At least 19 recordsLinked to original sources
PubMed2001

Current understanding and management of chronic hepatosplenic suppurative brucellosis.

To outline the characteristics and define appropriate management of chronic hepatosplenic suppurative brucellosis (CHSB), 905 patients with brucellosis were analyzed. Sixteen episodes of CHSB (14 in the liver and 2 in the spleen) were found in 15 patients. Six patients had had previous remote brucellosis. Twelve patients presented with systemic symptoms, and 12 with local symptoms. Cultures of blood samples yielded negative results in all cases except 1, and the results of cultures of pus specimens were positive for Brucella melitensis in only 2 cases. All patients showed calcium deposits surrounded by a hypodense area on computed tomography. Patients often had low titers of agglutinating antibody. In patients who were receiving conservative management, early response was successful in 50% and late response was successful in 33.3%. In the patients who underwent surgery and concomitant antibiotic therapy, early and late response was successful in 100%. Thus, CHSB mainly represents a local reactivation of previous brucellosis. Its diagnosis may be difficult to establish and surgery may be required to cure many patients.

Adult↗
PubMed2001

Efficacy of teicoplanin-gentamicin given once a day on the basis of pharmacokinetics in humans for treatment of enterococcal experimental endocarditis.

With the aim of investigating home therapy for enterococcal endocarditis, we compared the efficacy of teicoplanin combined with gentamicin given once a day or in three daily doses (t.i.d.) with the standard treatment, ampicillin plus gentamicin administered t.i.d., for treating experimental enterococcal endocarditis. The antibiotics were administered by using "human-like pharmacokinetics" (H-L), i.e, pharmacokinetics like those in humans, that simulated the profiles of these drugs in human serum. Animals with catheter-induced endocarditis were infected intravenously with 10(8) CFU of Enterococcus faecalis EF91 (MICs and MBCs of ampicillin, gentamicin, and teicoplanin, 0.5 and 32, 16 and 32, and 0.5 and 1 microg/ml, respectively) and were treated for 3 days with ampicillin H-L at 2 g every 4 h plus gentamicin H-L at 1 mg/kg every 8 h, or teicoplanin H-L at 10 mg/kg every 24 h, alone or combined with gentamicin, administered at dose of H-L at 1 mg/kg every 8 h or H-L at 4.5 mg/kg every 24 h. The results of therapy for experimental endocarditis due to EF91 showed that teicoplanin alone was as effective as ampicillin alone in reducing the bacterial load (P > 0.05). The combination of ampicillin or teicoplanin with gentamicin was more effective than the administration of both drugs alone in reducing the log(10)CFU/gram of aortic vegetation (P < 0.01 and P < 0.05, respectively). Teicoplanin plus gentamicin H-L at 4.5 mg/kg, both administered every 24 h, showed an efficacy equal to the "gold standard," ampicillin plus gentamicin H-L at 1 mg/kg t.i.d. (P > 0.05). Increasing the interval of administration of gentamicin to a single daily dose combined with teicoplanin resulted in a reduction of bacteria in the vegetations equivalent to that achieved with the recommended regimen of ampicillin plus thrice-daily gentamicin in the treatment of experimental endocarditis due to E. faecalis. Teicoplanin plus gentamicin, both administered once a day, may be useful home therapy for selected cases of enterococcal endocarditis.

Animals↗
PubMed2000

[A pancreatic pseudotumour of tuberculous etiology].

BACKGROUND: To review the clinical findings of pancreatic tuberculosis and to establish a differential diagnosis with pancreatic tumours. PATIENTS AND METHODS: To describe three cases of pancreatic tuberculosis diagnosed in a 850 bed teaching hospital during the last two years. RESULTS: In the three case the imaging procedures showed a pancreatic mass with hypodense area. One of the cases was erroneously initially diagnosed of a pancreatic tumour. In one case was diagnosed by a subcutaneous abscess puncture, in another by clinical suspicion and in third patient by laparotomy. Only one patient was immunosuppressed. All patients were cured with standard antituberculous therapy. CONCLUSIONS: Pancreatic tuberculosis should be considered in patients presenting with pancreatic tumours.

Aged↗
PubMed1999

Efficacy of ampicillin plus ceftriaxone in treatment of experimental endocarditis due to Enterococcus faecalis strains highly resistant to aminoglycosides.

The purpose of this work was to evaluate the in vitro possibilities of ampicillin-ceftriaxone combinations for 10 Enterococcus faecalis strains with high-level resistance to aminoglycosides (HLRAg) and to assess the efficacy of ampicillin plus ceftriaxone, both administered with humanlike pharmacokinetics, for the treatment of experimental endocarditis due to HLRAg E. faecalis. A reduction of 1 to 4 dilutions in MICs of ampicillin was obtained when ampicillin was combined with a fixed subinhibitory ceftriaxone concentration of 4 micrograms/ml. This potentiating effect was also observed by the double disk method with all 10 strains. Time-kill studies performed with 1 and 2 micrograms of ampicillin alone per ml or in combination with 5, 10, 20, 40, and 60 micrograms of ceftriaxone per ml showed a > or = 2 log10 reduction in CFU per milliliter with respect to ampicillin alone and to the initial inoculum for all 10 E. faecalis strains studied. This effect was obtained for seven strains with the combination of 2 micrograms of ampicillin per ml plus 10 micrograms of ceftriaxone per ml and for six strains with 5 micrograms of ceftriaxone per ml. Animals with catheter-induced endocarditis were infected intravenously with 10(8) CFU of E. faecalis V48 or 10(5) CFU of E. faecalis V45 and were treated for 3 days with humanlike pharmacokinetics of 2 g of ampicillin every 4 h, alone or combined with 2 g of ceftriaxone every 12 h. The levels in serum and the pharmacokinetic parameters of the humanlike pharmacokinetics of ampicillin or ceftriaxone in rabbits were similar to those found in humans treated with 2 g of ampicillin or ceftriaxone intravenously. Results of the therapy for experimental endocarditis caused by E. faecalis V48 or V45 showed that the residual bacterial titers in aortic valve vegetations were significantly lower in the animals treated with the combinations of ampicillin plus ceftriaxone than in those treated with ampicillin alone (P < 0.001). The combination of ampicillin and ceftriaxone showed in vitro and in vivo synergism against HLRAg E. faecalis.

Algorithms↗
PubMed1998

Favorable prognosis of purulent meningitis in patients infected with human immunodeficiency virus.

We prospectively reviewed all cases of purulent meningitis among human immunodeficiency virus (HIV) type 1-infected patients > 14 years old that occurred at the Hospital General Vall d'Hebron (Barcelona) during the period 1 January 1985 through 31 March 1997. There were 12 episodes of purulent meningitis in nine of 2,150 HIV-1-infected patients. The annual rate of purulent meningitis was 0.465 cases per 1,000 patients, a rate that is 150 times higher than that for the general population. During 10 episodes, CD4+ lymphocyte counts were < 200/mm3. The etiologic organism was Streptococcus pneumoniae in nine episodes (seven episodes occurred in four splenectomized patients), and Escherichia coli, Streptococcus agalactiae, and Enterococcus faecium each caused one episode. Clinical features and cerebrospinal fluid abnormalities were similar to those observed among patients without HIV-1 infection. All patients had bacteremia. The overall mortality was 8.3%. We conclude that purulent meningitis, particularly pneumococcal meningitis, is more frequent among HIV-1-infected patients than in the general population. The prognosis for HIV-1-infected patients is better than for HIV-1-negative patients.

Adult↗
PubMed1997

Bacteremia due to Campylobacter species: clinical findings and antimicrobial susceptibility patterns.

From 1979 to 1996, 58 patients (mean age, 39.4 years) were treated for bacteremia due to Campylobacter species at the Hospitals Vall d'Hebron in Barcelona, Spain. Bacteremia was considered to be hospital acquired in 30% of these patients. Almost all the patients (93%) had underlying conditions; liver cirrhosis was the most frequent (34% of patients), and neoplasia, immunosuppressive therapy, and human immunodeficiency virus disease were also common. Of the 58 Campylobacter strains isolated, 81% were C. jejuni, 10% were Campylobacter species, 7% were C. fetus, and one (2%) was C. coli. Resistance rates were: cephalothin, 82%; co-trimoxazole, 79%; quinolones, 54%; ampicillin, 20%; amoxicillin/clavulanate, 4%; erythromycin, 7%; gentamicin, 0; and tetracyclines, 0. Even though the majority of patients were immunocompromised, mortality was low (10.5%), and only one patient relapsed. Because of the high level of resistance to the quinolones in Campylobacter species, these drugs should not be used as empirical treatment, at least in Spain. Although the macrolides remain the antibiotics of choice, amoxicillin/clavulanate may be an effective alternative therapy.

Adolescent↗
PubMed1997

Treatment of experimental pneumonia due to penicillin-resistant Streptococcus pneumoniae in immunocompetent rats.

A model of pneumonia due to Streptococcus pneumoniae resistant to penicillin was developed in immunocompetent Wistar rats and was used to evaluate the efficacies of different doses of penicillin, cefotaxime, cefpirome, and vancomycin. Adult Wistar rats were challenged by intratracheal inoculation with 3 x 10(9) CFU of one strain of S. pneumoniae resistant to penicillin (MICs of penicillin, cefotaxime, cefpirome, and vancomycin, 2, 1, 0.5, and 0.5 microg/ml, respectively) suspended in brain heart broth supplemented with 0.7% agar. The rats experienced a fatal pneumonia, dying within 5 days and with peak mortality (70 to 80%) occurring 48 to 72 h after infection, and the bacterial counts in the lungs persisted from 8.87 +/- 0.3 log10 CFU/g of lung at 24 h of the infection to 9.1 +/- 0.3 log10 CFU/g at 72 h. Four hours after infection the animals were randomized into the following treatment groups: (i) control without treatment, (ii) penicillin G at 100,000 IU/kg of body weight every 2 h, (iii) penicillin G at 250,000 IU/kg every 2 h, (iv) cefotaxime at 100 mg/kg every 2 h, (v) cefpirome at 200 mg/kg every 2 h, and (vi) vancomycin at 50 mg/kg every 8 h. Two different protocols were used for the therapeutic efficacy studies: four doses of beta-lactams and one dose of vancomycin or eight doses of beta-lactams and two doses of vancomycin. Results of the therapy for experimental pneumonia caused by penicillin-resistant S. pneumoniae showed that initially, all the antimicrobial agents tested had similar efficacies, but when we prolonged the treatment, higher doses of penicillin, cefotaxime, and cefpirome were more effective than penicillin at lower doses in decreasing the residual bacterial titers in the lungs. Also, when we extended the treatment, vancomycin was more efficacious than penicillin at lower doses but was less efficacious than higher doses of penicillin or cefpirome. The model that we have developed is simple and amenable for inducing pneumonia in immunocompetent rats and could be used to explore the pathophysiology and to evaluate optimal therapy of this infection in the immunocompetent host.

Animals↗
PubMed1996

Treatment of experimental endocarditis due to Enterococcus faecalis using once-daily dosing regimen of gentamicin plus simulated profiles of ampicillin in human serum.

We compared the efficacy of ampicillin, both alone and in combination with gentamicin given once a day (q.d.) or three times a day (t.i.d.), in the treatment of experimental enterococcal endocarditis. Ampicillin was administered by using humanlike pharmacokinetics that simulated the profiles of this drug in human serum. An open one-compartment mathematical model developed in this study was used to estimate the decreasing doses administered with a computer-controlled infusion pump that simulated in rabbits the human serum pharmacokinetics after intravenous administration of 2 g of ampicillin every 4 h. Animals with catheter-induced endocarditis were infected intravenously with 10(8) CFU of Enterococcus faecalis J4 (MICs and MBCs of ampicillin and gentamicin, 2 and 128 and 16 and 64 micrograms/ml, respectively) and were treated for 3 days with ampicillin alone or in combination with gentamicin at 2 mg/kg of body weight subcutaneously t.i.d. or at 6 mg/kg subcutaneously q.d. The serum ampicillin levels and pharmacokinetic parameters of the humanlike pharmacokinetics of ampicillin in rabbits were similar to those found in humans treated with 2 g of ampicillin intravenously. The results of therapy for experimental endocarditis caused by E. faecalis J4 showed that the residual bacterial concentration in aortic valve vegetation was significantly lower in the animals treated with combinations of ampicillin plus gentamicin given q.d. or t.i.d. than in those treated with ampicillin alone (P < 0.01). The dosing interval of gentamicin did not significantly affect (q.d. versus t.i.d.; P = 0.673) the therapeutic efficacy of the combination of ampicillin plus gentamicin.

Ampicillin↗
PubMed1995

[Treatment and outcome of pneumococcal meningitis in adults. Study of a recent series of 70 episodes].

BACKGROUND: Pneumococcal meningitis (PM) is an infection with high morbidity and mortality. The aim of this study was to evaluate the most relevant clinical, epidemiologic and evolutive characteristics of a recent series of adult patients with this disease. METHODS: Over a period of 10 years all the patients with PM diagnosed by isolation of this microorganism in the cerebrospinal fluid (CSF) were evaluated from a clinical, therapeutic and evolutive points of view. The impact of the new therapies in the disease and the variables associated with mortality were analyzed. RESULTS: Seventy episodes of PM were diagnosed, 60% being found in patients over the age of 50 years. The male/female relationship was 2/1. Fifty-three percent of the patients had other underlying diseases. Acute otitis media (AOM) was the source in 34% of the cases, in 11% the patients had a fistula of CSF and in 9% a pneumonia. At the time of diagnosis 74% of the patients had some degree of reduction in the level of consciousness and in 40% of the episodes the presence of neurologic local manifestations were observed. A decrease in sensitivity to penicillin was observed in 33% of the microorganisms isolated. Third generation cephalosporins were used as initial treatment in 57 episodes and penicillin in other 11 episodes. Adjuvant treatment with dexamethasone, mannitol and/or diphenylhydantoin was administered in 54% of the patients. Overall mortality was 23%: the factors associated with an unfavourable evolution were the existence of underlying disease, deep alteration in the level of consciousness at the time of diagnosis, the coexistence of pneumonia and the absence of adjuvant therapy. CONCLUSIONS: Mortality in pneumococcal meningitis is high. The most relevant risk factor is the initial degree of consciousness. Adjuvant therapies probably determine a reduction in the rate of mortality.

Adult↗
PubMed1995

Sternotomy infection due to Mycoplasma hominis and Ureaplasma urealyticum.

Mycoplasma hominis infections outside the urogenital tract are uncommon. An unusual case of sternal infection caused by both Mycoplasma hominis and Ureaplasma urealyticum is described. This is the first report found in the literature of mixed infection due to these microorganisms at this site. The outcome was favourable after drainage of the surgical wound and antibiotic therapy with clindamycin, gentamicin and doxycycline.

Humans↗