DIFFERENCES BETWEEN AGAR DILUTION, BROTH MACRODILUTION (CLSI M27-A3) AND E TEST (AB BIODISK) FOR FLUCONAZOLE RESISTANCE IN CLINICAL CANDIDA ALBICANS ISOLATES

Ensayos de susceptibilidad realizadas por dilución en agar (AD) se compararon con M27-A3 macrodilución de caldo (BMD) metodología (Clinical Laboratory Standards Institute y) y la prueba E (AB BIODISK) con el fin de determinar la viabilidad y la fiabilidad de dilución en agar como una prueba de unexpensive para ensayos de susceptibilidad a fluconazol (FLC) contra Candida albicans. Un total de 40 cepas fueron utilizados. Todos los aislamientos resultaron en un acuerdo para la DMO y la prueba de evaluación. 19 aislados mostraron concordancia entre los tres métodos. De los 21 resultados divergentes, 20 resultaron en una mayor MIC para la EA y 15 de ellos fueron ≥ 64 mg / ml. La densidad de células debido a un contacto proporcional de las células con el fármaco en el medio puede ser responsable de los resultados obtenidos y la divergencia de AD en comparación con las otras pruebas. AD no son capaces de sustituir ni la DMO ni prueba E, pero puede ser útil como una prueba de resistencia a la tensión preliminar para la clasificación de susceptibilidad en la investigación de laboratorio. Abstract Susceptibility assays performed by agar dilution (AD) were compared to M27-A3 broth macrodilution (BMD) methodology (Clinical Laboratory and Standards Institute) and E test (AB BIODISK) in order to determine the feasibility and reliability of agar dilution as an unexpensive test for fluconazole (FLC) susceptibility assays against Candida albicans. A total of 40 strains were used. All of the isolates resulted in agreement for BMD and E test. 19 isolates showed agreement between all three methods. Of the 21 divergent results, 20 resulted in higher MIC for AD and 15 of those were ≥64 μg/ml. Cell density due to proportional contact of cells with the drug in medium may be responsible for the results obtained and the divergence of AD compared to the other tests. AD can’t reliably substitute neither BMD nor E test, but it may be helpful as a preliminary resistance test for strain susceptibility classification in laboratory research. Palabras clave: Candida albicans, hongo, resitencia de droga

Risk factors for infections caused by carbapenem-resistant Enterobacterales: an international matched case-control-control study (EURECA)

Cases were patients with complicated urinary tract infection (cUTI), complicated intraabdominal (cIAI), pneumonia or bacteraemia from other sources (BSI-OS) due to CRE; control groups were patients with infection caused by carbapenem-susceptible Enterobacterales (CSE), and by non-infected patients, respectively. Matching criteria included type of infection for CSE group, ward and duration of hospital admission. Conditional logistic regression was used to identify risk factors. Findings Overall, 235 CRE case patients, 235 CSE controls and 705 non-infected controls were included. The CRE infections were cUTI (133, 56.7%), pneumonia (44, 18.7%), cIAI and BSI-OS (29, 12.3% each). Carbapenemase genes were found in 228 isolates: OXA-48/like, 112 (47.6%), KPC, 84 (35.7%), and metallo-beta-lactamases, 44 (18.7%); 13 produced two. The risk factors for CRE infection in both type of controls were (adjusted OR for CSE controls; 95% CI; p value) previous colonisation/infection by CRE (6.94; 2.74-15.53; <0.001), urinary catheter (1.78; 1.03-3.07; 0.038) and exposure to broad spectrum antibiotics, as categorical (2.20; 1.25-3.88; 0.006) and time-dependent (1.04 per day; 1.00-1.07; 0.014); chronic renal failure (2.81; 1.40-5.64; 0.004) and admission from home (0.44; 0.23-0.85; 0.014) were significant only for CSE controls. Subgroup analyses provided similar results. Interpretation The main risk factors for CRE infections in hospitals with high incidence included previous coloni-zation, urinary catheter and exposure to broad spectrum antibiotics

Identification and susceptibility of clinical isolates of Candida spp. to killer toxins

Abstract Although invasive infections and mortality caused by Candida species are increasing among compromised patients, resistance to common antifungal agents is also an increasing problem. We analyzed 60 yeasts isolated from patients with invasive candidiasis using a PCR/RFLP strategy based on the internal transcribed spacer (ITS2) region to identify different Candida pathogenic species. PCR analysis was performed from genomic DNA with a primer pair of the ITS2-5.8S rDNA region. PCR-positive samples were characterized by RFLP. Restriction resulted in 23 isolates identified as C. albicans using AlwI, 24 isolates as C. parapsilosis using RsaI, and 13 as C. tropicalis using XmaI. Then, a group of all isolates were evaluated for their susceptibility to a panel of previously described killer yeasts, resulting in 75% being susceptible to at least one killer yeast while the remaining were not inhibited by any strain. C. albicans was the most susceptible group while C. tropicalis had the fewest inhibitions. No species-specific pattern of inhibition was obtained with this panel of killer yeasts. Metschnikowia pulcherrima, Pichia kluyveri and Wickerhamomyces anomalus were the strains that inhibited the most isolates of Candida spp

Survey on the use of premix insulin analogues in diabetes mellitus type 1 and 2 in Mexico [Encuesta sobre el uso de premezclas de an�logos de insulinas en pacientes con diabetes en M�xico]

Background: There are several publications related to the use of premixed insulin analogs in Type 1 and 2 Diabetes Mellitus, however, there was no information about its use in the Mexican clinical practice. Materials and methods: A survey was conducted to 48 physicians experts in Diabetes Mellitus. They were endocrinologists (62%), Internists (32) and diabetologists (6%). Results: Twenty-four percent of the specialists pointed out that more than half of the patients who consult by the first time do not respond to treatment with oral hypoglycemic medication. A high number of patients treated with insulin reach glycemic control goals. Most of the experts treat more than half of their patients with insulin. Sixty-six percent of the experts use premixed insulin analogs in their patients with type 1 Diabetes, and a high percentage use them in type 2 Diabetes. Most of the expert physicians recommend the use of premixed insulin analogs as the first line treatment in their patients diagnosed with Type 2 Diabetes. Conclusions: Premixed insulin analogs are widely accepted by patients because they offer a complete coverage of their metabolic requirements, reducing the number of daily injections. In type 1 Diabetes, premixed insulin analogs will be used to improve metabolic control and to strengthen compliance. This document describes the use of premixed insulin analogs in the treatment of Diabetes Mellitus in Mexico

Survey on the use of premix insulin analogues in diabetes mellitus type 1 and 2 in Mexico [Encuesta sobre el uso de premezclas de análogos de insulinas en pacientes con diabetes en México]

Background: There are several publications related to the use of premixed insulin analogs in Type 1 and 2 Diabetes Mellitus, however, there was no information about its use in the Mexican clinical practice. Materials and methods: A survey was conducted to 48 physicians experts in Diabetes Mellitus. They were endocrinologists (62%), Internists (32) and diabetologists (6%). Results: Twenty-four percent of the specialists pointed out that more than half of the patients who consult by the first time do not respond to treatment with oral hypoglycemic medication. A high number of patients treated with insulin reach glycemic control goals. Most of the experts treat more than half of their patients with insulin. Sixty-six percent of the experts use premixed insulin analogs in their patients with type 1 Diabetes, and a high percentage use them in type 2 Diabetes. Most of the expert physicians recommend the use of premixed insulin analogs as the first line treatment in their patients diagnosed with Type 2 Diabetes. Conclusions: Premixed insulin analogs are widely accepted by patients because they offer a complete coverage of their metabolic requirements, reducing the number of daily injections. In type 1 Diabetes, premixed insulin analogs will be used to improve metabolic control and to strengthen compliance. This document describes the use of premixed insulin analogs in the treatment of Diabetes Mellitus in Mexico