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Introduction: Parenteral nutrition (PN) is an integral part of medical management of patients who do not have a functioning or accessible gastrointestinal tract. This paper discusses the clinical characteristics of patients receiving PN in a 420-bed hospital from 2009 to 2011. In addition, nutritional parameters were assessed at the start and end of PN and associated complications were analyzed., Material and Methods: retrospective, observational study of PN episodes in adults conducted at the Nutrition Unit of Hospital Universitario de Guadalajara. Variables collected included epidemiological and clinical data, number and type of routes used, anthropometric data, analytical data, number of days on PN, reason for withdrawal, caloric provision, prevalence of phlebitis, metabolic complications (hypertriglyceridemia, abnormal liver function tests, hyperglycemia, and refeeding syndrome), and prevalence of bacteremia associated with central venous catheter (BAC)., Results: There were 312 episodes of PN. The immediate indication was postoperative ileus in 53.8% of the episodes. There was a statistically significant improvement in all analytical parameters assessed (albumin, prealbumin, retinol binding protein, transferrin, cholesterol, and lymphocytes). Caloric provision (kcal per kg) was 25.1±6.6. No metabolic complication occurred in 16.3% of the episodes, and hyperglycemia was the most common complication (79.8%). There were 10 cases of phlebitis (32.2%) and 30 episodes of BAC (8.7%). Bacteriemia rate was 8.1 per 1000 days of PN., Discussion: Although PN is an effective nutritional support technique, it is associated with complications of varying severity. Use of PN should therefore comply with the instructions accepted in the main clinical practice guidelines and requires careful monitoring by experienced professionals., (Copyright © 2012 SEEN. Published by Elsevier Espana. All rights reserved.)

We carried out a retrospective study of the susceptibility of 104 Streptococcus pyogenes strains, which were isolated in 2000 and 2001 from clinical samples of different origins, to penicillin, erythromycin, clindamycin, ofloxacin and levofloxacin. The susceptibility testing was performed using the agar difusion method according to the guidelines of the NCCLS. All of the isolates showed susceptibility to penicillin and clindamycin. However, we detected 11 strains that were resistant to erythromycin (10.6%) and 4 strains resistant to ofloxacin (3.8%). We studied the resistance phenotypes of macrolides and lincosamides using erythromycin and clindamycin discs. Nine of the eleven strains that were resistant to erythromycin showed an M phenotype, while the remaining two showed inducible resistance to clindamycin, thus suggesting an MLS(B) inducible phenotype. No strains with constitutive resistance to erythromycin or clindamycin (MLS(B) constitutive phenotype) were identified. While penicillin is still uniformly active against S. pyogenes, in Guadalajara, there are 10.6% strains that are resistant to 14- and 15-atoms macrolides.

Background: Corynebacterium urealyticum may produce severe urinary tract infections (UTI) in patients with renal transplantation (RT). The aim of this study was to define the prevalence, clinical spectrum and risk factors for the development of symptomatic UTI in RT receptors with bacteriuria by C. urealyticum., Methods: The clinical data of RT patients with bacteriuria by C. urealyticum diagnosed in the Hospital Doce de Octubre in Madrid from January 1990 to September 1993 were retrospectively reviewed. The patients corresponded to two clearly differentiated periods. In the first, the presence of C. urealyticum was not actively sought in the urine sample while in the second an intentional search was carried out in all the RT with a selective culture medium containing different antibiotics, Tween-80 and urea to facilitate C. urealyticum identification and growth., Results: C. urealyticum was isolated in the urine of 46 patients (14% of the RT performed in the study period). In the first phase 16 cases were diagnosed with 30 being found in the second with the selective medium. Bacteriuria by C. urealyticum was symptomatic in 18 patients (39%): 12 acute cystitis, one encrusted cystitis (IC), and 5 encrusted pyelitis (IP). Of the symptomatic patients 39% had a history of prolonged vesical catheterization, 27% carried ureteral catheterization and 50% had undergone other urologic manipulations. The clinical consequences were important with development of obstructive uropathy and alteration in renal function (28%), need for surgery (33%) and graft loss (5.5%). All the C. urealyticum strains were sensitive to vancomycin and teicoplanin which were useful in the treatment although the most severe cases (IC, IP) required surgery., Conclusions: The prevalence of UTI by Corynebacterium urealyticum is high in RT patients. Occasionally, these infections may have severe consequences, particularly in patients with a history of urologic manipulation, if early diagnosis is not performed and adequate antibiotic treatment given. A selective culture medium should be used to isolate C. urealyticum in RT patients.