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Biomedical subjects

M E García-Leoni

Publications and source records attributed to M E García-Leoni.

7 recordsLinked to original sources
PubMed1996

Emergence of teicoplanin-resistant coagulase-negative staphylococci.

Over a period of 5 years we have recovered 32 clinical isolates of coagulase-negative staphylococci (CoNS) exhibiting either decreased levels of susceptibility or true resistance to teicoplanin (MICs, 16 to 128 micrograms/ml); these isolates make up 0.55% of the total CoNS isolated by us. Twenty-nine of the strains were also methicillin resistant, and all were susceptible to vancomycin. Fourteen of the strains were Staphylococcus epidermidis, fourteen were Staphylococcus haemolyticus, and four were Staphylococcus hominis. In one case, a strain of S. haemolyticus was isolated with a vancomycin-resistant, teicoplanin-resistant Enterococcus faecalis strain. All strains were nosocomially acquired and were isolated from 17 different wards. Teicoplanin resistance occurred as a sporadic phenomenon, and none of the isolates were epidemiologically related. The isolates were from 30 patients, 13 of whom presented with true infections (43%). Five (38%) of the 13 patients with true infections had been previously treated with vancomycin. None of the infected patients were previously treated with teicoplanin. The in vivo development of resistance to teicoplanin among CoNS strains limits the therapy of infections by these microorganisms. There is a need for surveillance of nosocomial isolates of CoNS to determine resistance to glycopeptides.

Aged↗
PubMed1995

Infections caused by erythromycin-resistant Streptococcus pneumoniae: incidence, risk factors, and response to therapy in a prospective study.

To evaluate the incidence and the significance of resistance to erythromycin among clinical isolates of Streptococcus pneumoniae, we identified and prospectively followed all hospitalized patients in a 27-month period who had the organism isolated from any clinical sample. Patients who had an infection caused by pneumococci resistant to erythromycin (minimum inhibitory concentration, > 1 microgram/mL) were compared to those with infections caused by erythromycin-susceptible organisms. The incidence of erythromycin resistance among pneumococci doubled over the study period (from 7.6% in 1988 to 15.2% in 1992). Most strains (94%) showed resistance to multiple antibiotics, including other macrolides. By multivariate analysis, an age of < 5 years and nosocomial acquisition of the infection were independent risk factors for erythromycin resistance. Among patients with pneumococcal pneumonia caused by erythromycin-resistant organisms, 9 patients treated with third-generation cephalosporins were cured, while therapy with erythromycin failed for 2 of the 6 patients to whom it was administered. The rapid and significant increase of erythromycin resistance among clinical isolates of S. pneumoniae points to the need for routine surveillance of pneumococcal resistance.

Adolescent↗
PubMed1992

Pneumococcal pneumonia in adult hospitalized patients infected with the human immunodeficiency virus.

PURPOSE: To determine the attack rate; clinical, radiologic, and laboratory characteristics; and outcome of pneumococcal pneumonia in patients infected with the human immunodeficiency virus (HIV) and to compare these characteristics with those of pneumococcal pneumonia in the general population. PATIENTS AND METHODS: This is a retrospective (13-month), prospective (14-month) study. All adult hospitalized patients with pulmonary infiltrates and isolation of Streptococcus pneumoniae in blood, pleural fluid, transtracheal aspirate, or respiratory secretions obtained by plugged telescoped catheter (counts greater than 10(3) colony-forming units per milliliter) are included. MAIN RESULTS: We identified 22 HIV-infected patients and 84 HIV-seronegative patients with pneumococcal pneumonia (76% and 56%, respectively, were bacteremic). The estimated attack rate was 5.9 per 1000 for HIV-infected patients and 0.31 per 1000 for HIV-seronegative patients. Pneumococcal pneumonia was the first manifestation of HIV infection in 48% of cases. Seventy-two percent of patients younger than 40 years of age with pneumococcal pneumonia were HIV infected. No predisposing factors for pneumococcal pneumonia were identified in 76% and 2% of HIV seropositive and seronegative patients, respectively. Clinical and radiologic presentation was similar in the two populations. Of all S pneumoniae isolates, 35% were resistant to penicillin and 10% to erythromycin, without differences in the two groups. Prognosis was good, with only one infection-related death in the HIV-infected group (10 patients died in the other group). No relapses were documented in HIV-infected patients. CONCLUSION: The HIV-infected patient is at increased risk for pneumococcal pneumonia and bacteremia. Patients younger than 40 years of age who present with pneumococcal pneumonia should be considered for HIV testing, since it may be the first manifestation of HIV infection. Specific antimicrobial therapy is curative in the majority of HIV-infected patients.

AIDS Serodiagnosis↗
PubMed1992

Susceptibility of Streptococcus pneumoniae to penicillin: a prospective microbiological and clinical study.

We performed a prospective study of all infections with Streptococcus pneumoniae documented during a 22-month period at our hospital. A total of 163 clinically significant strains of S. pneumoniae were isolated from 139 patients whose ages ranged from 8 days to 91 years (mean +/- SD, 42.6 years +/- 26.8 years). Twenty percent of the patients had cancer, and 18% were infected with the human immunodeficiency virus. Pneumococcal infection was nosocomially acquired in one-fourth of cases. One-third of patients had nonpneumonic disease. A wide range of serotypes were isolated, and 42.5% of all strains were nonsusceptible--i.e., showed either intermediate or high-level resistance--to penicillin. The rates of resistance to chloramphenicol, erythromycin, and tetracycline were 23%, 10.8%, and 48.2%, respectively. Twenty-two percent of the infected patients died, with a 15.8% mortality directly attributable to pneumococcal infection. Factors associated with infection by strains of S. pneumoniae not susceptible to penicillin included an age of less than or equal to 10 years, immunosuppression, the presence of a rapidly fatal underlying disease, previous antimicrobial therapy, and infection by serotypes 14 and 23. All clinically significant isolates of S. pneumoniae should be submitted for antimicrobial susceptibility studies, and, whenever a high prevalence of resistance to penicillin and macrolides is detected, the use of these well-established empirical therapeutic regimens should be reconsidered.

Adolescent↗
PubMed1990

High incidence of tuberculosis in renal patients.

The incidence and clinical characteristics of mycobacteriosis in patients attending the nephrology department in a hospital in Madrid, Spain, during a 30-month period were analysed retrospectively. Twenty-two new cases of tuberculosis were detected among 525 patients studied. No cases of clinically significant atypical mycobacteriosis were found. The estimated overall annual incidence of tuberculosis in these patients was 259 cases per 100,000 population, which is much higher than the national annual incidence in Spain of 35 per 100,000 population. Most cases were asymptomatic when diagnosed and extrapulmonary involvement was the rule (86% of all patients). In areas with a high prevalence of tuberculosis, renal patients in high-risk groups (renal transplant recipients, haemodialysis and CAPD patients) should be examined periodically to exclude silent infection.

Humans↗