We performed a nested case-control study (ratio of 1:4) on the emergence of tigecycline-resistant multidrug-resistant Klebsiella pneumoniae (TR-MDRKP) isolates among patients who initially presented with a tigecycline-susceptible MDRKP isolate. Out of 260 patients, 24 (9%) had a subsequent clinical culture positive for a TR-MDRKP isolate within the 90-day follow-up period. On logistic regression analyses, receipt of tigecycline (adjusted odds ratio [OR], 5.06; 95% confidence interval [CI], 1.80 to 14.23; P ‫؍‬ 0.002) was the only independent predictor of subsequent isolation of a TR strain.T igecycline, a minocycline derivative, remains one of the few therapeutic options for the treatment of infections caused by multidrug-resistant Klebsiella pneumoniae (MDRKP) isolatesincluding Klebsiella pneumoniae carbapenemase (KPC) producers-and other Gram-negative organisms (1, 2). Of concern, tigecycline nonsusceptibility (i.e., tigecycline resistance [TR]) among Klebsiella pneumoniae isolates has been reported from different continents and ranged between 0% and 11.5% in a recent large study (3-6). Furthermore, several recent case studies identified patients who were treated with tigecycline for an initially tigecycline-susceptible MDRKP (TS-MDRKP) infection but from whom a TR-MDRKP strain was subsequently isolated (7-10). However, the potential of in vivo emergence of TR among MDRKP isolates has so far not been systematically investigated to our knowledge. We intended to study the rates of and risk factors for the in vivo emergence of TR among Klebsiella pneumoniae isolates in a large population of patients who initially presented with a TS-MDRKP.We performed a nested case-control study on the subsequent emergence of TR among all patients from whom a TS-MDRKP strain was previously isolated at a tertiary care center between January 2008 and July 2011. MDRKP was defined as the presence of either an extended-spectrum ␤-lactamase (ESBL)-or KPCproducing Klebsiella pneumoniae isolate, determined as per Clinical and Laboratory Standards Institute (CLSI) guidelines on ESBL testing, carbapenem resistance patterns, and Hodge test results, respectively (11, 12). Food and Drug Administration (FDA) breakpoints were applied to interpret the results of tigecycline susceptibility testing using the disc diffusion method and Etest (susceptible if the zone diameter is Ն19 mm and the isolate MIC is Յ2 g/ml, respectively).A case was defined as a patient from whom a TR-MDRKP was isolated between Ͼ48 h and Ͻ90 days after the day a TS-MDRKP strain was isolated (zero time). A control was defined as a patient from whom a TS-MDRKP strain was isolated during the study period but with no subsequent TR-MDRKP strains. Controls were matched to cases based on the isolate's resistance mechanism (ESBL versus KPC) but otherwise randomly selected in a 1:4 ratio. Cases were compared to controls with regard to a variety of demographic and clinical characteristics. We also recorded (i) all antibiotic exposures within 90 days before zero time and (ii) all antib...

SUMMARYHuman fascioliasis is a growing health problem, with an increasing worldwide incidence of reported cases. Improving its diagnosis through more sensitive and specific techniques is important to clinical practice and to epidemiology, specially to determine new endemic areas. Objective: To evaluate coprological techniques and serological tests for diagnosis of Fasciola hepatica (Fh) infection in humans. Material and methods: The study population involved children aged from 1 to 16 years, in a highly endemic area (Junin, Perú). A total of 194 stool samples and 158 sera were examined. Three coprological techniques were compared: formolether concentration (Ritchie's), spontaneous sedimentation (SST) and Lumbreras' rapid sedimentation (RST). Three serological test for Fh were evaluated: Arc 2 (double-diffsion), enzyme-linked immunoelectrotransfer blot (EITB) and Fas2-ELISA. Results: RST showed higher recovery rates (20.61%) of eggs in stools than SST (13.40%) and Ritchie's (7.72%). The sensitivity of the serological tests was compared with total infected patients diagnosed by all the fecal tests: most sensitive was Fas2-ELISA with 96.77%, EITB was 71.87% and Arc 2, was 34.48%. Conclusion: We conclude that RST is better than the SST and Ritchie's techniques for the diagnosis of the chronic phase of human infection by Fh using fecal examinations, and that Fas2-ELISA is a very highly sensitive immunodiagnostic test, which may be used for the diagnosis of human Fh infection in both clinical and epidemiological settings, specially for screening human populations living in endemic areas. ( Rev Med Hered 2002; 13: 49-57 ).

Objetivo: Observar la prevalencia y factores asociados de parasitosis intestinal en Jauja, Junín. Material y métodos: Se incluyeron a 188 individuos entre 1 y 16 años de edad de los distritos de Huertas y Julcán, provincia de Jauja, departamento de Junín, Perú. A 161 se les realizó entrevista y examen clínico. Resultados: La prevalencia de parasitosis intestinal fue alta, el 100% de ellos tenían parásitos o comensales y el 64% alojaban patógenos. Las características sociodemográficas de esta población muestran las precarias condiciones de vida, pobres hábitos higiénicos y hacinamiento humano en que viven, esto explicaría la alta endemicidad de parasitosis intestinal. Los enteroparásitos más frecuentes fueron Giardia lamblia (35.1%) y Fasciola hepática(19.1%). La asociación parasitaria que tuvo significación estadística fue la de Ascaris lumbricoides y Trichiuris trichiura (p<0.05). El dolor abdominal fue el síntoma más frecuente observado. El método diagnóstico con mayor rendimiento para el diagnóstico de parasitosis en general fue la Técnica de sedimentación espontánea en tubo (TSET), excepto para el diagnóstico de la fasciolosis donde la Técnica de sedimentación rápida de Lumbreras tuvo mejor rendimiento. Conclusiones: La alta endemicidad de parasitosis intestinal es causada por las precarias condiciones de vida, pobres hábitos higiénicos y hacinamiento humano presente en esta población. La alta prevalencia de fasciolosis humana en estas poblaciones demuestra que esta zoonosis es un problema de Salud Pública. ( Rev Med Hered 2002; 13: 85-89).