Le e s
o
he
Edi o s
499
Spa loxacin and clina loxacin we e he mos ac i e
agen s agains
cip o loxacin-suscep ible
E. aecium
s ains
(Table
2).
Pe loxacin, howe e , was he leas ac i e
agen , yielding an MIC230 alue o
16
nig/L. I , again,
a b eakpoin o
1
mg/L
is applied, none o he s ains
was suscep ible
o
pe loxacin. No loxacin and o loxacin
also showed e y low ac i i y agains hese s ains.
Fo
cip o loxacin- esis an
E.
aecium
s ains. all he quino-
lones showed MIC5o alues lowe han hose obse ed
agains cip o loxacin- esis an
E. aecu1is
s ains. In e ms
o
MIC90
clina loxacin was again he mos ac i e
luo oquinolone agains cip o loxacin- esis an
E.jhecium
s ains, 42% and
51%
o hese s ains we e inhibi ed by
1
mg/L o spa loxacin and clina loxacin, espec i ely.
The high in i o ac i i y o clina loxacin agains
en e ococci has been desc ibed
[6,7].
Ne e heless, he
MICso alues ob ained in his s udy a e g ea e han
hose ob ained in p e ious s udies, sugges ing
a
slow
dec ease in he suscep ibili y o en e ococci
o
his
agen . The o he new quinolones, le o loxacin, spa -
loxacin and o a loxacin, did no imp o e on he
esul s ob ained wi h clina loxacin.
In summa y, clina loxacin, and
o
a
lesse ex en
spa loxacin, le o loxacin and o a loxacin, showed
g ea e in i o ac i i y han he classical luo o-
quinolones agains en e ococci. Taking in o accoun
he ew he apeu ic al e na i es o in ec ions caused by
nul i esis an s ains, u he expe imen al s udies will
be needed
o
de e mine i hese new luo oquinolones
will be use ul in he ea men o se ious en e ococcal
in ec ions caused by s ains esis an
o
o he an ibio ics.
Acknowledgmen s
This wo k was pa ially suppo ed by
a
g an (PB94-
1424)
om he Di ecci6n Gene al de In es igacion
Cien i ica
y
Tkcnica
(DGICYT),
Spain. The au ho s
hank P. Hidalgo and
J.
Dawson o he p epa a ion o
he manusc ip .
Luis
Ma inez-ll.~a i~~ez',
P o idencia
Joyanes
',
Al u o
Pascual',
Eu ique
Te e o
I,
E elio
J
Pe ea'
'Depa men o Mic obiology,
Uni e si y Hospi al
V.
Maca ena,
School o Medicine, Se ille, Spain;
'Depa men o Mic obiology,
School o Medicine, Apdo 914,
41080-Se ille, Spain
Re e ences
1.
E no i TG, Gaynes
RP.
An o e iew o nosocomial
in ec ions, including he ole o he mic obiology labo a o y
Clin Mic ob Re 1993;
6:
428-42.
2.
Go don
S,
Swenson JM, Hill BC, e
al.
An imic obial
suscep ibili y pa e ns o
comnion
and unusual species
o
en e ococci cau ing in ec ions
iii
he Uni ed S a es.
J
Clin
Mic obiol
2992;
30: 2373-8.
Ba y AI, Fuchs PC. C oss- esis ance and c osg- uscep ibili y
be ween luo oquinolone agen s. Eu J Clin Mic obiol In ec
Dis
1991;
10:
1013-18.
Facklam
RR,
Sahm
DE
En e ococcus.
In
Mu ay
PR,
Ba on EJ,
P alle
MA, Teno e FC, Yolken
RH,
eds.
Manual o clinical mic obiology, 6 h
edn.
Washing on,
LIC:
Ame ican Socie y o Mic obiology, 1995:
308-1
4.
Na ional Commi ee o Clinical Labo a o y S andud .
Me hods
o
dilu ion an imic obial suscep ibili y es o
bac e ia ha g ow ae obically, 3 d edn. App o ed S anda d.
NCCLS documen M7-A3. Villano a, PA: Na ional
Com-
mi ee o Clinical Labo a o y S anda ds, 1993.
Bu ney
S,
Landman
U,
Quale JM. Ac i i y o clina loxacin
agains mul id ug- eqis an
En c ococcus
$eciimi.
An imic ob
Agen s Chenio he 1994;
38:
1668-70.
I'iddock LJV
New
quinoloiies
and
G am-pos1 i e bac e ia.
An imic ob Agen s Chemo he 1994; 38:
163-9.
Use ulness
o
delayed hype sensi i i y skin es s in
HIV
in ec ed pa ien s
Clin Mic obiol
In ec
1997;
3:
499-500
The demands on he heal h se ices by pa ien s in ec ed
wi h ype
1
human immunode iciency i us (HIV-1)
a e inc easing ma kedly.
In
Spain, pas o p esen
in a enous d ug use s accoun o
a
signi ican p o-
po ion o he
o al
in ec ed indi iduals [I]. Thei isi s
o doc o s a e andom and do no i in o de ined
pa e ns.
In his con ex , i
is
ex emely impo an o ob ain
objec i e da a which may help in he e alua ion
o
hei se ologic, diagnos ic and clinical s a us. Delayed
hype sensi i i y skin es s p o ide
a
e y impo an
diagnos ic ool o assessing cellula immuni y and
se e al au ho s ha e ad oca ed hei use in clinical
p ac ice
a
he ini ial e alua ion
[2,3].
A he same ime,
lymphocy e CD4 coun s ha e become widely accep ed
as
an indica o when assigning
a
p ophylac ic o he a-
peu ic egimen and in es ablishing li e-expec ancy
[4,5]. This indica o has gained uni e sal cu ency wi h
he publica ion o he la es CDC c i e ia o s aging
and clinical ca ego iza ion
[6].
The objec i e o he p esen wo k is o e alua e he
esponse o
a
skin es consis ing o i e bac e ial and
wo ungal an igens (Ag)
in
a
sample o
HIV-1
in ec ed
indi iduals a hei i s isi
o
he doc o and o
es ablish i s ela ion
o
he
CD4
lymphocy e coun .
Be ween Oc obe 1985 and Ma ch
1993
we s udied
a
o al o
503
indi iduals wi h isk ac o s who p esen ed
o clinical e alua ion
a
he Uni e si y Clinical Hospi al
o
Valladolid. Thei a e age age was
29
k
7
yea s ( ange:
500
Clinical Mic obiology and In ec ion,
Volume 3 Numbe
4,
Augus 1997
16-74)
and
72%
we e males. Nine y- wo pe cen o
hese subjec s had
a
his o y o pas o p esen in a-
enous d ug
use.
A
cu aneous skin es was pe o med
in
all
he pa ien s
a
he beginning o he s udy wi h
Mul i es
IMC
(Ins i u MC ieux, Lyon), which in-
cludes
Clos idiu n e ani, Co ynebac e ium diph he iae,
S ep ococcus
g oup
C,
Mycobac e ium ube culosis, P o eus
mi abilis, Candida
albicans
and
T ichophy on men ag o-
phy es,
and i was ead
48-72
h la e . We also ob ained
an absolu e
CD4
lymphocy e coun on pe iphe al
blood. The Mul i es esponse was classi ied as ‘no mal’
when he e was ank esponse
o
mo e han wo
an igens, ‘pa ial’ i he e was esponse o one o wo
an igens, and ‘ane gic’ when no eac i i y o eac i i y
below con ol le el (glyce in) was ound. The chi-
squa ed s a is ical
es
was used o making com-
pa isons.
Table
1
Rela ionship be ween cu aneous Mul i es and
CD4
lymphocy e coun
CD4
lymphocy es/mn3
Response
o
cu aneous Mul i es
No.
<200
2200
is wo old. Fi s , hese pa ien s a e in equen clinic
a ende s and also ha e di icul enous access; skin
es ing may pa ly help o o e come his di icul y.
Second, he e
is
a11 inc easing p oblem o ube culosis
in hese pa ien s; mul iple skin es s a e help ul in
assessing he alue o Man oux es ing. One impo an
di icul y emains: ensu ing ha he eading o he skin
es s is homogeneous. Ideally, we should de e mine he
in e -obse e a ia ion (K-COe lCien ); mo e s udies
a e necessa y in o de o con ol he in o ma ion bias
de i ed om he in e p e a ion ca ied ou
by
se e al
obse e s.
Jose
Ma
Ei os,
P udencio Ma inez,
Rad
O iz
de
Leja azu,
An onio
O duiia,
Luis Inglada, An onio Roddguez-To es2
‘Mic obiologia, Facul ad de Medicina,
A da Rambn y Cajal,
7,
47005
Valladolid, Spain;
2Facul ad de Medicina y Hospi al Clinic0
Uni e si a io, Valladolid, Spain
No maVPa ial 329
20
309
Ane gic
174
21 153
To al SO3 41 462
Abno mal o pa ial esponses o Mul i es IMC
we e seen in
329
pa ien s and
174
we e ane gic. Table
1
shows hese da a ca ego ized acco ding o he o al
CD4
lymphocy e coun . We ound ha in ane gic
pa ien s he ela i e
isk
o ha ing
a
CD4
coun
<200/mm3
was
1.985 (95%
CI:
1.107-3.561, p<0.02).
The e was no signi ican di e ence in e ms
o
CD4
coun be ween no mal and pa ial esponde s. We
chose his ‘cu -o acco ding o
CD4
cell ca ego y
(subg oup
3)
in he
CDC
classi ica ion. This impo an
associa ion (delayed hype sensi i i y es ing wi h
CD4)
should be clinically use ul in HIV+ in a enous d ug
use s, pa icula ly in de eloping coun ies which do
no ha e easy access
o
CD4
coun moni o ing. I
seems clea ha i al load
is
he mos use ul ma ke o
disease p og ession.
Ou da a a e in line wi h hose o en ound in
clinical s udies
[3,7]
and suppo he u iliza ion o apid
es s in clinical p ac ice. In ou expe ience he cu aneous
Mul i es is
a
aluable al e na i e in he con ex o
ini ial clinical e alua ion, o e ing a good co ela ion
wi h
CD4
ci cula ing le els, because o
i s
low cos and
easy applica ion. In ou p ac ice wi h
a
la ge p opo ion
o in a enous d ug use s who a e HIV in ec ed, he
p ac ical impo ance o delayed hype sensi i i y es ing
Re e ences
1. Regis o Nacional de Casos de Sida. Vigilancia Epidemio-
16gica de SIDA en Espa ia a echa de ac ualizaci6n
31
de
diciemb e de 1995. Pub O Seisida 1996; 7:
325-35.
2. Caia a WT, Ghaham NM, Galai N,
RIZZO
RT, Nelson
KE,
Vlaho D. Ins abili y o delayed- ype hype sensi i i y skin es
ane gy in human immunode iciency i us in ec ion. A ch
In e n Med 1995; 155: 2111-17.
3. Dolan MJ, Cle ici M, Bla
SP,
e
al.
In i o
T
cell unc ion,
delayed- ype hype sensi i i y shn es ing, and CD4+
T
cell
subse pheno yping independen ly p edic su i al ime
in pa ien s in ec ed wi h human immunode iciency i us.
J
In ec Dis 1995; 172: 79-87.
4. Sa a ola z
L,
Nea on JD, Sacks
L,
Dey on
L,
Rhame
F,
She e
R
o he Te y Bei n Communi y P og ams o Clinical
Resea ch on AIDS. CD4+
T
lyniphocy e coun s and pa e ns
o
mo ali y among pa ien s in ec ed wi h human immuno-
de iciency i us
who
we e en olled in communi y p og ams
o clinical esea ch on AIDS. Clin In ec Dis 1996; 22:
5.
S ein DS, Ko ick JA, Ve mund
SH.
CD4+ lymphocy e cell
enume a ion o p edic ion o clinical cou se o human
immunode iciency i us disease:
a
e iew.
J
In ec Dis 1992;
6. CDC 1993. Re ised classi ica ion sys em o HIV in ec ion
and expanded su eillance case de ini ion o
AIDS
among
adolescen s and adul s.
MMWR
1992; 41: 1-19.
7. Huebne
RE,
Schein
MF,
Hall
CA,
Ba nes SA. Delayed- ype
hype sensi i i y ane gy in human immunode iciency i us-
in ec ed pe sons sc eened o in ec ion wi h
Mycoba e ium
ube culo b.
Clin In ec Dis 1994; 19: 26-32.
513-20.
165:
352-63.