Infections due to extended-spectrum beta-lactamase (ESBL)-producing Escherichia coli (ESBLEC) in nonhospitalized patients seem to be emerging in different countries. Their incidence, epidemiology, and clinical impact in the community have not been studied. We describe the epidemiology and clinical features of infections caused by ESBLEC in nonhospitalized patients in Spain and the results of a case-control study performed to investigate the risk factors associated with the acquisition of these organisms. The clonal relatedness of the organisms was assessed by repetitive extragenic palindromic sequence PCR. The ESBLs and the genes encoding the ESBLs were initially characterized by isoelectric focusing and PCR, respectively. Forty-nine patients (76% with urinary tract infections, 22% with asymptomatic bacteriuria, and 2% with acute cholangitis) were included. Six patients were bacteremic. Diabetes mellitus (odds ratio, 5.5; 95% confidence interval, 1.6 to 18.7), previous fluoroquinolone use (odds ratio, 7.6; 95% confidence interval, 1.9 to 30.1), recurrent urinary tract infections (odds ratio, 4.5; 95% confidence interval, 1.3 to 15.1), a previous hospital admission (odds ratio, 18.2; 95% confidence interval, 5.3 to 61.1), and older age in male patients (odds ratio per year, 1.03; 95% confidence interval, 1.03 to 1.05) were identified as risk factors by multivariate analysis. The ESBLEC isolates were not clonally related. The ESBLs were characterized as members of the CTX-M-9 group, the SHV group, and the TEM group in 64, 18, and 18% of the isolates, respectively. ESBLEC is an emergent cause of urinary tract infections in nonhospitalized patients. There was no evidence of horizontal transmission of ESBLEC strains. Avoidance of fluoroquinolone use in high-risk patients should be considered whenever possible in order to avoid the selection of these organisms.Extended-spectrum beta-lactamase (ESBL)-producing members of the family Enterobacteriaceae are resistant to penicillins, narrow-and extended-spectrum cephalosporins, and aztreonam (4). ESBL-producing organisms are also frequently resistant to aminoglycosides, trimethoprim-sulfamethoxazole, and quinolones.Until recently, most infections caused by ESBL-producing Escherichia coli (ESBLEC) or Klebsiella pneumoniae had mostly been described as nosocomially acquired (4) or nursing home related (32). However, some recent data suggest that infections due to ESBL-producing organisms might be an emergent problem in outpatients in different countries (1,8,9,11,14,15), but detailed epidemiological data were not collected in most of those studies. Moreover, the clinical relevance and the epidemiology of these infections outside nursing homes have not been studied.In a recent nationwide study of ESBL-producing organisms in Spain, 93% of ESBL-producing K. pneumoniae strains were isolated from inpatients, while 51% of ESBL-producing E. coli (ESBLEC) strains were isolated from outpatients (13) Consequently, we conducted the study described in this report, in which we describe an...

The purpose of this study was to investigate the effect of melatonin, at pharmacological doses, on serum lipids of rats fed with a hypercholesterolemic diet. Therefore, different groups of animals were fed with either the regular Sanders Chow diet or a diet enriched in cholesterol. Moreover, animals were treated with or without melatonin in the drinking water for 3 months. We show that melatonin treatment did not affect the levels of cholesterol or triglycerides in rats fed with a regular diet. However, the increase in total cholesterol and low‐density lipoprotein (LDL)‐cholesterol induced by a cholesterol‐enriched diet was reduced significantly by melatonin administration. On the other hand, melatonin administration prevented the decrease in high‐density lipoprotein (HDL)‐cholesterol induced by the same diet. No differences in the levels of very low‐density lipoprotein (VLDL)‐cholesterol and triglycerides were found. We also found that melatonin administration slightly decreased serum uric, bilirubin and increased serum glucose levels. Other biochemical parameters, including total proteins, creatinine, urea, phosphorus, calcium, glutamic oxalacetic transaminase (GOT), glutamic pyruvic transaminase (GPT), Γ‐glutamyltranspeptidase (Γ‐GT), acetyl cholinesterase (AcCho), and alkaline phosphatase (ALP) were not modified by melatonin treatment. Finally, lipid peroxidation (LPO) was studied in membranes of liver, brain, spleen, and heart as an index of membrane oxidative damage. Results show that hypercholesterolemic diet did not modify the LPO status in any of the tissues studied. However, chronic melatonin administration significantly decreased LPO. Results confirm that melatonin participates in the regulation of cholesterol metabolism and in the prevention of oxidative damage to membranes.

The results further support the concept that osteocalcin levels in GCF correlates with periodontal but not with osteoporosis status.

The epidemiology of ESBL-producing E. coli as a cause of nosocomial infection is complex. Sporadic CTX-M-producing isolates coexisted with epidemic multidrug-resistant SHV-TEM-producing isolates. These data should be taken into account for the design of control measures.

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