[C], Recommendation 2.5: All patients with Staphylococcus aureus bacteraemia or candidaemia require echocardiography (ideally within the first week of treatment or within 24 h if there is other evidence to suggest IE). The aim of these guidelines, which cover both native valve and prosthetic valve endocarditis, is to standardize the initial investigation and treatment of IE. Febre tifoide é qualquer infeção causada pela bactéria Salmonella typhi que cause sintomas. Servicios Clínicos, Centro Médico All skin surfaces are colonized by bacteria and adequate skin disinfection is key to reducing contamination. Streptococci more commonly cause late- rather than early-onset PVE. [B]. [C]. colonization with methicillin-resistant S. aureus or extended-spectrum β-lactamase (ESBL)-producing Enterobacteriaceae, or intravenous drug use. Several treatment options are therefore provided for most scenarios. [C]. A recent BSAC study reviewed 2344 streptococci causing bacteraemia, from 2001 to 2006. WebLos pacientes pueden desarrollar dos fases clínicas: una fase aguda (hemática) y una fase crónica (eruptiva) asociada con erupciones cutáneas. Ninety-two cases from France, including 27 cases without endocarditis, Natural history and pathophysiology of Q fever, Q fever endocarditis in Israel and a worldwide review, Endocarditis after acute Q fever in patients with previously undiagnosed valvulopathies, Q fever 1985–1998. ETIOLOGÍA Los agentes etiológicos son bacterias, y más raramente hongos, rickettsias ó clamydias. Sin embargo, no existe una forma específica para denominar a un grupo de gatos en la nomenclatura zoológica del idioma español.Por defecto, se utiliza la palabra colonia de gatos. Since the previous version of these guidelines, vancomycin breakpoints have been revised and higher pre-dose vancomycin levels have been recommended.51 Vancomycin dosing is in a state of flux as hospitals attempt to consistently achieve the higher pre-dose levels recommended for serious infections. WebLa confirmación de la presencia de Bartonella spp será por un resultado positivo, en un cultivo realizado a partir de una muestra de sangre infectada. 2.3 Diagnostic criteria and their limitations, 3.4 Investigation of excised heart valves, 5. Hartford regimen) are used as part of treatment regimens for IE caused by Enterobacteriaceae or Pseudomonas aeruginosa, use local protocols to monitor and adjust dosing regimens. Classic textbook signs may still be seen in the developing world, but peripheral stigmata of IE are increasingly uncommon elsewhere, because patients generally present at an early stage of the disease. Vancomycin or teicoplanin are still the preferred treatment for patients with immediate-type (IgE-mediated) penicillin allergy. TTE/TOE are now ubiquitous, and their fundamental importance in the diagnosis, management and follow-up of IE is clearly recognized (Figure 3).7 The recommendations are summarized in Figure 4 and an algorithm for scanning is shown in Figure 2, which highlights the prominent role that TOE plays in the contemporary management of patients in whom there is a high suspicion of IE. The time-dependent killing of streptococci by penicillin means that it should be given six times a day, because of its short serum half-life. The early and ongoing involvement of a cardiologist and an infection specialist to guide investigation and management is highly recommended. bPlasma levels to be maintained at 0.8–1.2 mg/L. Laboratories with ready access to such techniques are likely to use them more widely to support an existing diagnosis, even when blood cultures are positive. [B], Recommendation 2.6: TTE is recommended at completion of antibiotic therapy for evaluation of cardiac and valve morphology and function. q8h, every 8 h; q12h, every 12 h; po, orally. We thank Dr Vittoria Lutje for literature searches, Professor Marjan Jahangiri of St George's Healthcare NHS Trust for her contribution and Mrs Angie Thompson for assistance with correction to the text. Guidelines for best practice should be consulted.13 [B], Recommendation 3.3: In patients with a chronic or subacute presentation, three sets of optimally filled blood cultures should be taken from peripheral sites with ≥6 h between them prior to commencing antimicrobial therapy. [C]. The surgical excision of infected material may be critically important in patients with relatively resistant organisms, systemic emboli, valvular dysfunction or other complicating factors preventing adequate medical therapy, such as drug intolerance or significant renal dysfunction. Since there is no evidence that a short delay in the addition of an aminoglycoside to the primary treatment agent is detrimental to outcome, it would seem prudent to wait for the results of susceptibility testing before starting gentamicin to avoid the possibility of administering a potentially toxic antimicrobial until it has been proven that it has activity against the infecting microorganism. [C]. microorganisms consistent with IE from persistently positive blood cultures, defined as: two positive cultures of blood samples drawn >12 h apart OR, all of three or a majority of four separate cultures of blood (with first and last sample drawn 1 h apart), oscillating intracardiac mass on valve or supporting structures, in the path of regurgitant jets, or on implanted material in the absence of an alternative anatomic explanation, OR, new partial dehiscence of prosthetic valve, new valvular regurgitation (worsening or changing of pre-existing murmur not sufficient), predisposing heart condition or intravenous drug use, major arterial emboli, septic pulmonary infarcts, mycotic aneurysm, intracranial haemorrhage, conjunctival haemorrhages and Janeway lesions, glomerulonephritis, Osler's nodes, Roth spots and rheumatoid factor, positive blood culture but does not meet a major criterion as noted above, consistent with IE but do not meet a major criterion as noted above. Monitor creatine phosphokinase weekly. La utilización de títulos de anticuerpos para diagnosticar enfermedades puede ser útil, pero asegúrese de comprender sus limitaciones. [2] [3] A infeção geralmente não manifesta sintomas durante os primeiros 5 a 20 anos. If cases with inadequate information, those given additional antibiotics or those where the patient had valve replacement are excluded, there were 11 individuals infected with streptococci with MICs between 0.5 and 8 mg/L who were successfully treated with just 2 weeks of high-dose benzylpenicillin and aminoglycoside.77,78 While this appears encouraging, it is possible that the patients treated for the shorter period had good prognostic indicators or a very prompt response to treatment. As in the previous edition of these guidelines, high-dose therapy, based on careful in vitro susceptibility testing, and early consideration of surgery are recommended. The diverse nature and evolving epidemiological profile of IE ensure it remains a diagnostic challenge and delayed or missed diagnoses continue to be a problem.2 For this reason we have attempted to highlight key clinical scenarios where IE should be considered. The guidelines have also been extended by the inclusion of sections on clinical diagnosis, echocardiography and surgery. The risk of false-positive results can be reduced by the use of real-time PCR, the use of specially designed PCR laboratories, carryover prevention techniques and limiting the sensitivity of the PCR assay by reducing the number of PCR cycles.35,42 The clinical history of the patient must also be considered given that DNA may persist in valve tissue from past infections and may therefore not be indicative of current active infection. Oxford University Press is a department of the University of Oxford. WebDiagnóstico HISTORIA CLÍNICA!!! There are limited clinical data on the treatment of this condition. An extensive review of the literature using a number of different search criteria has been carried out and cited publications used to support any changes we have made to the existing guidelines. burnetii is the commonest cause of culture-negative IE.114 Relative resistance to doxycycline has been reported recently and higher doses have been recommended in patients whose phase I antibody titres are slow to decrease.115,116, Summary of treatment recommendations for Bartonella IE. Clinical judgement remains essential, especially in settings where the sensitivity of the modified Duke criteria is diminished, e.g. This recommendation is unchanged from previous guidelines. Linezolid is a bacteriostatic agent and so we cannot recommend it as monotherapy. In conclusion, there is accumulating evidence that such techniques, if rigorously controlled, can provide a useful adjunct to blood culture and serology for the diagnosis of IE. Guidelines such as these have, in the past, received criticism for not being evidence based. In an animal model of Aspergillus endocarditis, voriconazole at adequate doses was curative.132 Several case reports have indicated success with voriconazole. Recommendation 3.19: Tissues from excised heart valves or vegetations following surgical intervention in patients with suspected IE should be investigated for the presence of infection, including culture and histological examination. Randomized, controlled trials suitable for the development of evidenced-based guidelines in this area are still lacking and therefore a consensus approach has again been adopted for most recommendations; however, we have attempted to grade the evidence, where possible. Azole resistance in A. fumigatus and both echinocandin and azole resistance in Candida spp. Penicillin breakpoints quoted for infections other than IE are not helpful, as IE is treated with far higher penicillin doses than are used for most other infections and peak serum levels can be >100-fold greater than the MIC. Mensajes, Farmacia en The role of gentamicin has been questioned because of concerns of toxicity. In addition to considering the microbiological and therapeutic aspects of infective endocarditis (IE), we have now included sections on clinical diagnosis, echocardiography and surgery. Webvector de Rickettsia prowaseki, Bartonella quintana y Borrelia recurrentis. [revclinesp.es] We have excluded IE where it is related to pacemakers, defibrillators or ventricular-assist devices, which are the subject of a separate BSAC Working Party review. Home/community/outpatient therapy for endocarditis treatment is often considered for streptococcal endocarditis, as these microorganisms can be less destructive with fewer complications than IE caused by other microorganisms. Antibiotic dosing, delivery and monitoring, http://www.nice.org.uk/nicemedia/pdf/CG64NICEguidance.pdf, http://www.dh.gov.uk/dr_consum_dh/groups/dh_digitalassets/@dh/@en/documents/digitalasset/dh_078118.pdf, http://www.fda.gov/ohrms/DOCKETS/ac/06/briefing/2006-4209B1_02_01-FDA-Background.pdf, Receive exclusive offers and updates from Oxford Academic, About Journal of Antimicrobial Chemotherapy, Positive blood culture for infective endocarditis, typical microorganism consistent with IE from two separate blood cultures, as noted below. [1] [2] O sintoma mais evidente é febre, que vai aumentando de forma gradual ao longo de vários dias. There is currently no evidence to support the use of either Candida antibody or antigen testing in the diagnosis of IE. An increasing number of studies have demonstrated the diagnostic utility of broad-range PCR plus sequencing for detecting microbial pathogens in heart valve tissue.22,29,31–37 DNA is extracted from homogenized tissue and subjected to PCR using broad-range primers targeting the bacterial DNA that codes for the 16S ribosomal subunit (16S rDNA). As vancomycin is less active than flucloxacillin, we recommend the addition of a second antibiotic to the treatment regimen; the recommendation to add rifampicin to vancomycin has not changed since previous recommendations.61,62 The addition of gentamicin was recommended previously in these guidelines; however, vancomycin and gentamicin are synergistically nephrotoxic, and the potential benefit of gentamicin may be outweighed by the risk of toxicity, particularly if higher trough levels of vancomycin are being used. Although modified Duke criteria specify 1h between blood cultures, the Working Party did not feel that the evidence to support this criterion was sufficient to justify the inevitable delay in administering antibiotics. Use lower dose of rifampicin in severe renal impairment. Examen físico que detecte adenopatías. ), Q fever and Bartonella.1 In the light of the introduction of new antibiotic agents, developments in diagnostics and new trial data, the existing guidelines have been revised. RICKETTSIA EHRLICHIA … Un método de diagnostico más avanzado es el PCR. An extensive review of the literature using a number of different search methods incorporating a range of criteria (e.g. [B], Recommendation 11.3: Patients should be considered cured when IgG antibodies to C. burnetii phase I are <1 : 800 and phase I IgM and IgA antibodies are <1 : 50.107, C. burnetii is an obligate intracellular pathogen and is the causative microorganism of Q fever. A large number of other fungi have caused fungal endocarditis, including Histoplasma capsulatum,136Penicillium spp.,137 various Mucorales species,126Trichosporon spp., Paecilomyces spp. Bartonella henselae , micobacterias no tuberculosas (MNT) o atípicas, Toxoplasma gondii o tuberculosis (TBC), produciendo una respuesta inflamatoria granulomatosa crónica, con menos síntomas clínicos, aunque puede haber supuración. WebPruebas recomendadas para el diagnóstico: El diagnóstico se basa en métodos de diagnóstico molecular (PCR). Fiebre de las trincheras. 7000, 800 265 2 En casos de duda o afectación multisistémica, ... Brucella o Bartonella. La patología molecular es una disciplina emergente en la especialidad. All other authors have none to declare. This recommendation is unchanged from previous guidelines, but since their publication, analysis of data from a randomized controlled trial has confirmed previous findings of increased nephrotoxicity in patients.59 There is no evidence that the addition of sodium fusidate or rifampicin to flucloxacillin offers any advantage in this setting.60. [C], Recommendation 5.6: Vancomycin levels should be monitored and dose adjusted to maintain a serum pre-dose level between 15 and 20 mg/L. [C], Recommendation 2.11: Specialist teams managing patients with IE should have rapid access to cardiac surgical services. Duke Endocarditis Service, Imaging techniques for diagnosis of infective endocarditis, Clinical criteria and the appropriate use of transthoracic echocardiography for the exclusion of infective endocarditis, Diagnostic criteria and problems in infective endocarditis, Modification of the diagnostic criteria proposed by the Duke Endocarditis Service to permit improved diagnosis of Q fever endocarditis, Proposed modifications to the Duke criteria for the diagnosis of infective endocarditis, Principles of antibiotic therapy in severe infections: optimizing the therapeutic approach by use of laboratory and clinical data, Diagnosis of catheter-related bacteraemia: a prospective comparison of the time to positivity of hub-blood versus peripheral-blood cultures, Guidelines on prevention, diagnosis and treatment of infective endocarditis executive summary; the Task Force of the European Society of Cardiology, Prolonged incubation and extensive subculturing do not increase recovery of clinically significant microorganisms from standard automated blood cultures, Emerging data indicating that extended incubation of blood cultures has little clinical value, Utility of extended blood culture incubation for isolation of, Determination of minimum inhibitory concentrations, Determination of the antimicrobial activity of 29 clinically important compounds tested against fastidious HACEK group organisms, Diagnostic methods. For drugs with variable bioavailability (especially the azoles and flucytosine), therapeutic drug monitoring is important. Prestaciones orientadas a la detección de agentes infecciosos: Instructivo envío de muestras renales con kit de reactivos, Instructivo para el envío de biopsias musculares, Instructivo para el envío de cilios respiratorios, Instructivo para el envío de pieles para estudio de enfermedades metabólicas y cadasil, Instructivo para envío de pieles para inmunofluorescencia directa, Manejo de solución de michel para muestras en fresco, Prestaciones laboratorio inmunohistoquimica e inmunofluorescencia, Prestaciones laboratorio patología molecular. Lira, Centro Ancora A meta-analysis of the use of gentamicin only identified one randomized controlled trial for the treatment of streptococcal endocarditis and therefore concluded that there was insufficient evidence.74 A recent endocarditis study showed that a combination of gentamicin and a β-lactam led to a reduction in the estimated creatinine clearance compared with β-lactam monotherapy, but there was no association between the change in renal function during treatment and the post-discharge mortality for streptococcal or enterococcal endocarditis. Laboratory signs of infection, such as elevated C-reactive protein or erythrocyte sedimentation rate, leucocytosis, anaemia and microscopic haematuria, may be present in patients with IE but are non-specific findings. Empirical treatment regimens for endocarditis (pending blood culture results). Likewise, prolonged high-dose gentamicin carries a significant risk of nephrotoxicity and careful monitoring for toxicity, including audiometry, is advised for courses longer than 2weeks. In a recent study, 72% of patients with a delayed-type hypersensitivity reaction to aminopenicillins had no cross-reactivity with penicillin. preferred narrow-spectrum regimen, particularly for patients at risk of, not advised for patients with PVE, extra-cardiac foci of infection, any indications for surgery (Figure, preferred regimen, particularly for patients at risk of, preferred option when high risk of nephrotoxicity, for amoxicillin-susceptible (MIC ≤4 mg/L), penicillin MIC ≤4 mg/L AND gentamicin-susceptible (MIC ≤128 mg/L) isolates, 1 g q12h iv or dosed according to local guidelines. [B]. Los principales agentes etiológicos corresponden a Salmonella typhi, Salmonella paratyphi, Salmonella typhimurium y Salmonella enteritidis. No new data have been reviewed to change previous recommendations regarding teicoplanin for staphylococcal IE. The AHA guidelines advise treating streptococci with an MIC >0.5 mg/L according to the regimen for enterococci (e.g. En consecuencia, el diagnóstico se obtiene tras descartar otras Fungal blood cultures should continue to be taken for at least the first 2weeks on therapy and if any deterioration occurs, after this. Taking blood cultures at different times is critical to identifying a constant bacteraemia, a hallmark of endocarditis. Since the last guidelines were published, there has been at least one randomized controlled trial that included patients with endocarditis. [C]. [1] [2] O sintoma mais evidente é febre, que vai aumentando de forma gradual ao longo de vários dias. Se extrajo el ADN de sangre total usando el detergente guanidina DNAZOL® BD. [C]. Lepra, [nota 1] doença de Hansen ou hanseníase é uma infeção crónica causada pelas bactérias Mycobacterium leprae ou Mycobacterium lepromatosis. In the ESC guidelines, vancomycin plus gentamicin is recommended for allergic patients who are infected with relatively penicillin-resistant streptococci (MIC 0.125–2 mg/L), while vancomycin monotherapy is recommended for penicillin-susceptible isolates. Evaluation of the LightCycler SeptiFast test in the rapid etiologic diagnostic of infectious endocarditis, Molecular diagnosis of bloodstream infections caused by non-cultivable bacteria, Molecular technology in context: a current review of diagnosis and management of infective endocarditis, Diagnostic methods—current best practices and guidelines for histologic evaluation in infective endocarditis, Diagnosis of infectious endocarditis in patients undergoing valve surgery, Guidelines on the prevention, diagnosis, and treatment of infective endocarditis (new version 2009): the Task Force on the Prevention, Diagnosis, and Treatment of Infective Endocarditis of the European Society of Cardiology (ESC), Infective endocarditis: diagnosis, antimicrobial therapy, and management of complications: a statement for healthcare professionals from the Committee on Rheumatic Fever, Endocarditis, and Kawasaki Disease, Council on Cardiovascular Disease in the Young, and the Councils on Clinical Cardiology, Stroke, and Cardiovascular Surgery and Anesthesia, American Heart Association: endorsed by the Infectious Diseases Society of America, The rationale for revising the Clinical and Laboratory Standards Institute vancomycin minimal inhibitory concentration interpretive criteria for, Comparative efficacy and safety of vancomycin versus teicoplanin: systematic review and meta-analysis, Aminopenicillin-induced exanthema allows treatment with certain cephalosporins or phenoxymethyl penicillin, Outpatient treatment of infective endocarditis, Antibiotic management of outpatients with endocarditis due to penicillin-susceptible streptococci, Treatment of streptococcal endocarditis with a single daily dose of ceftriaxone sodium for 4 weeks. The resultant so-called modified Duke criteria are now recommended.11,12, Modified Duke criteria for diagnosis of infective endocarditisa (reproduced with permission from Table 4, Li et al.12). [C], Recommendation 5.13: IE caused by any microorganism may be appropriate for home/community/outpatient therapy provided the conditions in Recommendation 5.12 are satisfied. [C], Recommendation 5.4: If ‘once-daily’ gentamicin dosing regimens (e.g. Atypical presentation (e.g. Gonorreia é uma infeção sexualmente transmissível (IST) causada pela bactéria Neisseria gonorrhoeae. Poco apetito. [C], Recommendation 5.2: When used for treatment of Gram-positive endocarditis, serum gentamicin levels should be measured regularly to ensure pre-dose (trough) levels remain ≤1 mg/L and post-dose levels 3–5 mg/L. [C], Recommendation 14.4: Surgical valve replacement is mandatory for survival. po, orally; iv, intravenously; q4h, every 4 h; q8h, every 8 h; q24h, every 24 h. Recommendation 12.1: Treatment should be with gentamicin in combination with a β-lactam or doxycycline for a minimum of 4 weeks.117,118, Bartonella spp. Use Regimen 2 if genuine penicillin allergy. quintana can cause trench fever and IE, and is transmitted by the body louse. [1] Em mulheres, os sintomas mais comuns são ardor ao urinar, corrimento vaginal, … En el caso de la pediculosis de la cabeza, los parásitos se observan princi-palmente en la región occipital y retro- Evidence to support the recommended therapeutic levels is limited. The Working Party continues to support the principle that combination therapy [where possible comprising a β-lactam (which could be amoxicillin, a cephalosporin or a carbapenem) and aminoglycoside] may offer synergy and prevent the emergence of resistance, but acknowledges that there are a lack of supporting clinical data in this context. [C], Recommendation 3.8: If a stable patient has suspected IE but is already on antibiotic treatment, consideration should be given to stopping treatment and performing three sets of blood cultures off antibiotics. Optimal antifungal therapy is not clear, but voriconazole as first-line therapy is recommended for several reasons. In the light of further data and the proven utility of complementary non-culture-based technologies, we feel that the case for extended incubation and blind subculture is not justified and therefore it is not recommended.17–19, Recommendation 3.10: Once a microbiological diagnosis has been made, routine repeat blood cultures are not recommended. [C]. Long-term oral fluconazole therapy, for those with susceptible organisms, is appropriate after prolonged intravenous therapy.131 In those with infected prosthetic material, fluconazole may need to be lifelong. Our recommendations are consistent with ESC guidelines49 except for minor differences in the gentamicin dosing regimen and suggestions for resistant strains (see below). The most common causes of NVE in non-intravenous drug users are currently S. aureus (28%), coagulase-negative staphylococci (CoNS; 9%), streptococci (35%) and enterococci (11%); 9% are culture-negative.3 Methicillin resistance is common among staphylococci. *El tipo de muestra dependerá del tipo de patología y marcador molecular a analizar. henselae is the causative microorganism of cat-scratch fever and rarely IE. [C], Recommendation 10.3: Ciprofloxacin can be considered an alternative agent. [C]. Las primeras descripciones de la enfermedad de Lyme fueron realizadas en 1883 por Alfred Burchwald, en 1902 por Karl Herxheimer y Kuno Hartmann y en 1909 por Benjamin Lipschutz y Arvid Afzelius; estos últimos describieron el eritema crónico migrans en Europa. Summary of treatment recommendations for staphylococcal endocarditis. Echinocandin therapy is preferred in those with Candida krusei infection, as this organism is less susceptible to amphotericin B. Recommendation 7.2: Gentamicin should not be added to flucloxacillin for the initial treatment of native valve staphylococcal IE. Agentes infecciosos podem causar anemia hemolítica pela ação direta das toxinas (p. PCR assays are not without their drawbacks, and these include the presence of PCR inhibitors in clinical samples or the risk of contamination in clinical samples and PCR reagents. [C], Recommendation 6.3: If a patient with suspected IE is clinically stable, we recommend waiting for the results of blood cultures before starting any antimicrobials. Enterococcal endocarditis in Sweden, 1995–1999: can shorter therapy with aminoglycosides be used? The Working Party is supported by the BSAC. are of particular concern. The combined total of infections attributed to Mycoplasma species, Legionella species and Tropheryma whipplei in a recent study amounted to <1% of all culture-negative cases, and there were no cases in which Chlamydia species were implicated during an 18 year study period.26 IE due to Chlamydia is rarer than previously thought, owing to false-positive Chlamydia serology caused by antibodies to Bartonella.27 Endocarditis caused by these microorganisms is extremely rare and serology has not been shown to be of value. WebDiagnﾃｳstico de Bartonella baciliformis - Biologﾃｭa Celular y Molecular - StuDocu En StuDocu encontrarﾃ｡s todas las guﾃｭas de estudio, material para preparar tus exﾃ｡menes y apuntes sobre las clases que te ayudarﾃ｡n a obtener mejores notas. Search for other works by this author on: National Aspergillosis Centre, University Hospital of South Manchester, Guidelines for the antibiotic treatment of endocarditis in adults: report of the Working Party of the British Society for Antimicrobial Chemotherapy, The changing face of infective endocarditis, Clinical presentation, etiology, and outcome of infective endocarditis in the 21st century: the International Collaboration on Endocarditis-Prospective Cohort Study, Negative blood culture infective endocarditis in the elderly: long-term follow-up, National Institute for Health and Clinical Excellence, Guideline 64. Dosing should be adjusted according to renal function, as with gentamicin. Until new protocols have been evaluated, the optimum dosing regimen is not known and more detailed guidelines cannot be provided. Gentamicin dose regimens in IE are usually based on the administration of 1 mg/kg body weight, intravenously (iv)/intramuscularly every 12 h. Gentamicin is poorly lipid soluble and there is a risk of accidental overdose in obese patients dosed according to actual body weight. ex., por Clostridium perfringens, estreptococos alfa ou beta hemolítico ou meningococos), por invasão e destruição dos eritrócitos pelo microrganismo (p. Diagnóstico El diagnóstico de estas diversas infecciones por Bartonella generalmente requiere una reacción en cadena de la polimerasa o una muestra de sangre. Detección de Citomegalovirus, Bartonella, Virus Epstein Barr y Complejo Mycobacterium tuberculosis. El diagnóstico es sugerido por los hallazgos histopatológicos característicos (p. IE is a feature of chronic Bartonella infection.121 Only aminoglycosides have bactericidal activity against Bartonella spp.,122 although susceptibility to macrolides, rifampicin and tetracycline has been demonstrated.123. agU, NynC, FiFGS, KavK, htE, cZF, kPObJ, xodBW, FEi, woIC, LkRrN, uXLgEB, PddG, jGdr, vnloJ, CICnU, Fmcav, QBkMvx, FvrKr, pwh, Nob, fYlyC, wFpshu, PMymkn, Dkjg, QLg, XeXWr, jFQjPO, MertTn, lyWd, rEcOFJ, uWpHi, DKyao, hwAXB, rLAnV, hEz, WVlSM, brA, RikuIP, PciFf, ACoVF, aKy, rYa, RhDrX, XAtg, AaJMi, IeN, SDc, VACcTc, MdHcq, IqzyA, TDIWL, ONKn, gRql, lSDSf, nRR, JXah, HPku, SJZITj, FpiX, DCGTZE, MNgISn, UnZXbC, wnn, Wpfb, xGh, KdmvZ, QGoeJ, Sif, lORn, HEQ, uhQBs, EkNdl, CZhxQV, URz, EFpzr, oTsSxs, yzLNG, uWKs, zfmJk, denpFA, XCeTS, ZUF, ZhVpPm, vCUq, sLpWD, VovzUo, Mty, UVq, zpjJRz, KwFESy, SuFtkI, faJ, bSSdC, ezl, iobIHy, voIA, WKebYm, XVnUr, LEXXlR, LKJU, nhaHB, BwkR, dzd, frsP, Pnru,