Decrease in the Incidence of Tetracycline Resistance in Strains of Neisseria gonorrhoeae in the Nineties: Disminución en la Incidencia de la Resistencia a la Tetraciclina en Cepas de Neisseria gonorrhoeae en los Noventa

Antibiotic resistance determined by standard disc-diffusion method on GC agar with supplement B in 583 strains of Neisseria gonorrhoeae encountered between 1991 and 1996 at the University Hospital of the West Indies, Kingston, Jamaica, were analyzed. The level of penicillin resistance varied between 40% and 28% over the years. Tetracycline resistance fell from 44.2% in 1991 to 23.9% in 1996. Twenty-one per cent of the isolates were resistant simultaneously to both penicillin and tetracycline in 1991. The percentage of such strains decreased to 6.5% in 1996. Ceftriaxone was introduced as a first line drug in treatment of gonococcal infections in the late 1980s. The declining trend of tetracycline resistance may be due to a decrease in the usage of tetracycline in recent years. La resistencia antibiótica determinada por el método estándar de difusión por disco sobre agar GC con suplemento B, fue analizada en 583 cepas de Neisseria gonorrhoeae encontradas entre 1991 y 1996 en el Hospital Universitario de West Indies, Kingston, Jamaica. El nivel de resistencia a la penicilina varió entre 40% y 28% a través de los años. La resistencia a la tetraciclina cayó de 44.2% en 1991 a 23.9% en 1996. El 21% de las cepas aisladas eran simultáneamente resistentes a la penicilina y la tetraciclina en 1991. El promedio de estas cepas disminuyó a 6.5% en 1996. La ceftriaxona se introdujo como medicamento de primera línea en el tratamiento de las infecciones gonocócicas a finales de 1980. La tendencia a disminuir que presenta la resistencia a la tetraciclina puede deberse a una disminución en el uso de la tetraciclina en los años recientes

Resistance in Clinical Isolates of Enterococcus faecalis Encountered at the University Hospital of the West Indies, Jamaica

Enterococcus faecalis isolates were examined by an automated identification and susceptibility system. Almost all of the 97 isolates were ampicillin susceptible (n = 86) and tetracycline resistant (n = 89). All were nitrofurantoin susceptible. About a third of isolates showed high level resistance to the aminoglycosides streptomicin and gentamicin and this was usually associated with ciprofloxacin resistance (n = 34). Seven isolates were vancomycin resistant, including one that was ampicillin resistant. Most forms of resistance described elsewhere were found. "Resistencia en los Aislados Clínicos de Enterococcus Faecalis Encontrada en el Hospital Universitario de West Indies, Jamaica" RESUMEN Aislados de enterococcus faecalis fueron examinados mediante un sistema automatizado de identificación y susceptibilidad. Casi todos los 97 aislados examinados fueron susceptibles a la ampi-cilina (n = 86) y resistentes a la tetraciclina (n = 89). Todos fueron susceptibles a la nitrofurantoína. Alrededor de una tercera parte de los aislados mostró un alto nivel de resistencia a los aminoglicósidos, por regla general asociada con la resistencia a la ciprofloxacina (n=34). Siete aislados resultaron resistentes a la vancomicina, incluyendo uno que fue resistente a la ampicilina. Se encontraron la mayoría de las formas de resistencia descritas en otras partes

Coagulase Negative Staphylococci from Blood Cultures Contaminantes o Patógenos?

Detailed clinical data, underlying conditions, inflammatory indices and microbiological parameters in 60 patients who had pure growth of coagulase negative staphylococci from their blood culture specimens at the University Hospital of the West Indies, Jamaica, were analyzed and the clinical significance of the isolates ascertained using standard criteria. This study was undertaken between April and September 2003. The isolates were true pathogens of bloodstream infections in only 5 of the 60 patients (8.4%). In the vast majority ie 44 of 60 (73.3%) they were mere blood culture contaminants and in 11 (18.3%), the clinical significance could not be ascertained. Fifteen of the 44 patients (34%) with contaminating coagulase negative staphylococci were treated with specific anti-staphylococcal antibiotics; 5 (11.4%) with vancomycin. Although there has been a relative increase of coagulase negative staphylococcal infections including bloodstream infections in recent years, the organisms still remain the most common contaminants in blood cultures. Over 70% of isolates were contaminants in this study which is similar to that in a number of such studies in other parts of the world. The findings underline the need for careful evaluation of coagulase negative staphylococci isolated from blood cultures before instituting therapy to avoid unnecessary use of antibiotics, especially vancomycin, and the consequent increase of antibiotic resistance in hospitals. "Estafilococos Coagulasa-Negativos de Cultivos de Sangre: Contaminantes o Patógenos? RESUMEN Los datos clínicos detallados, las condiciones subyacentes, los índices inflamatorios así como los parámetros microbiológicos de 60 pacientes que presentaron crecimiento puro de estafilococos coagu-lasanegativos de sus cultivos de sangre en el Hospital Universitario de West Indies, Jamaica, fueron sometidos a análisis. De este modo, se pudo determinar la significación clínica de los aislados, usando criterios estándar. En sólo 5 de los 60 pacientes (8.4%), los aislados resultaron ser realmente pató-genos de infecciones del torrente sanguíneo. En la gran mayoría, a saber 44 de 60 (73.3%), se trataba tan sólo de contaminantes en el cultivo de la sangre, y en 11 (18.3%) no pudo determinarse la impor-tancia clínica. Quince de los 44 pacientes (34%) con estafilococos coagulasa-negativos contaminantes, fueron tratados con antibióticos antiestafilocócicos específicos, y 5 (11.4%) con vancomicina. Aunque en años recientes ha habido un aumento relativo de infecciones por estafilococos coagulasa-negativos–incluyendo infecciones del torrente sanguíneo – los organismos siguen siendo todavía los contaminantes más comunes en los cultivos de sangre. Más del 70% de los aislados resultaron ser contaminantes en este estudio: un resultado similar al obtenido en una serie de estudios de este tipo realizado en otras partes del mundo. Los hallazgos apuntan a la necesidad de realizar una evaluación cuidadosa de los estreptococos coagulasa-negativos aislados en los cultivos de sangre antes de proceder a instituir la terapia, a fin de evitar el uso innecesario de antibióticos – en especial la vancomicina – y el consiguiente aumento de la resistencia antibiótica en los hospitales

Hepatic Abscesses at the University Hospital of the West Indies: A 24-year Autopsy Review

A retrospective review of all hepatic abscesses identified at autopsy over the 24-year period 1977-2000 at the University Hospital of the West Indies (UHWI), Kingston, Jamaica, was conducted. Post mortem and microbiology records were reviewed. Data collected included age, gender, predisposing factors, organisms isolated, number of abscesses and associated conditions, such as diabetes mellitus. Data for the adults was analyzed separately. Thirty-nine cases of pyogenic abscesses were identified from 7480 post-mortems. Thirty-three occurred in adults of mean age 59.5 years. Sixty per cent of the abscesses were solitary. Biliary tract disease was the predisposing factor in 33% of cases. Six per cent were cryptogenic: 11/33 patients were diabetic and these were significantly older than non-diabetics (p < 0.014) Klebsiella pneumoniae was the most common organism isolated from diabetics (6/9). Only 2/33 abscesses were diagnosed ante-mortem. The abscesses in children were more frequently multiple and associated with extra-abdominal infection. Gram positive cocci were the commonly isolated organisms in children. There were no cases of amoebic abscess. The prevalence of hepatic abscess was low. Diabetes mellitus was a significant contributing factor. A high index of clinical suspicion is therefore warranted particularly in elderly diabetics

"Epidemiology of Coagulase-Negative Staphylococci Isolated from Clinical Blood Specimens at the University Hospital of the West Indies"

The prevalence and significance of coagulase negative staphylococci (CoNS) isolated from blood cultures at the University Hospital of the West Indies (UHWI) during a six-month period were investigated. Standard and automated microbiological procedures were used to process 3001 blood culture specimens received from 2363 patients and 658 (21.9%) of the blood cultures yielded 854 bacterial isolates. The highest prevalence of positive blood cultures (60%) and the lowest prevalence of blood isolates of CoNS (12%) were found in the intensive care unit (ICU). The blood isolates of CoNS were most frequent in the surgical wards (13%) and lowest in obstetrics and gynaecology (2%). High rates of resistance to methicillin, other anti-staphylococcal penicillins, and cephalosporins used in the treatment of CoNS were observed. All blood isolates of CoNS (100%) were susceptible to vancomycin. In conclusion, the results show that coagulase-negative staphylococci are the most prevalent bacterial isolates in blood cultures at the UHWI occurring mostly as contaminants. The practice of proper venepuncture and hand-washing techniques by medical staff are recommended to facilitate appropriate antibiotic usage. "Epidemiología de los Estafilococos Coagulasa Negativos Aislados de Especímenes Clínicos de Sangre en el Hospital Universitario de West Indies" RESUMEN Se investigó la prevalencia e importancia de los estafilococos coagulasa negativos (ECoN) aislados de cultivos de sangre en el Hospital Universitario de West Indies (HUWI) por un período de seis meses. Se utilizaron procedimientos microbiológicos estándar y automatizados para procesas 3001 cultivos de sangre recibidos de 2363 pacientes y 658 (21.9%) de los cultivos dieron 854 aislados bacterianos. La más alta prevalencia de cultivos de sangre positivos (60%) y la más baja prevalencia de aislados de ECoN (12%) se encontraron en la Unidad de Cuidados Intensivos (UCI). Los aislados de sangre de ECoN fueron más frecuentes en las salas de cirugía (13%) y más bajos en las de obstetricia y ginecología (2%). Se observaron altas tasas de resistencia a la meticilina, así como a otras penicilinas antiestafilocócicas y cefalosporinas usadas en el tratamiento de ECoN. Todos los aislados de sangre de ECoN (100%) fueron susceptibles a la vancomicina. En conclusión, los resultados muestran que los estafilococos coagulasa negativos son los aislados bacterianos más prevalentes en cultivos de sangre en el HUWI, presentándose en la mayor parte de los casos como contaminantes. Se recomienda la práctica de técnicas adecuadas de venepuntura y lavado de manos por parte del personal médico a fin de facilitar un uso antibiótico correcto