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Rev Esp Quimioter 2020; October 19

Recommendations for use of antigenic tests in the diagnosis of acute SARS-CoV-2 infection in the second pandemic wave: attitude in different clinical settings

FRANCISCO JAVIER CANDEL, PABLO BARREIRO, JESÚS SAN ROMÁN, JUAN CARLOS ABANADES, RAQUEL BARBA, JOSÉ BARBERÁN, CARLOS BIBIANO, JESÚS CANORA, RAFAEL CANTÓN, CRISTINA CALVO, MAR CARRETERO, FERNANDO CAVA, RAFAEL DELGADO, JULIO GARCÍA-RODRÍGUEZ, JUAN GONZÁLEZ DEL CASTILLO, CRISTINA GONZÁLEZ DE VILLAUMBROSIA, MONTSERRAT HERNÁNDEZ, JUAN EMILIO LOSA, FRANCISCO JAVIER MARTÍNEZ-PEROMINGO, JOSÉ MARÍA MOLERO, PATRICIA MUÑOZ, ELENA ONECHA, MAMIKO ONODA, JUAN RODRÍGUEZ, MARTA SÁNCHEZ-CELAYA, JOSÉ ANTONIO SERRA, ANTONIO ZAPATERO

Published: 19 October 2020

http://www.doi.org/10.37201/req/120.2020

The high transmissibility of SARS-CoV-2 before and shortly after the onset of symptoms suggests that only diagnosing and isolating symptomatic patients may not be sufficient to interrupt the spread of infection; therefore, public health measures such as personal distancing are also necessary. Additionally, it will be important to detect the newly infected individuals who remain asymptomatic, which may account for 50% or more of the cases. Molecular techniques are the “gold standard” for the diagnosis of SARS-CoV-2 infection. However, the massive use of these techniques has generated some problems. On the one hand, the scarcity of resources (analyzers, fungibles and reagents), and on the other the delay in the notification of results. These two facts translate into a lag in the application of isolation measures among cases and contacts, which favors the spread of the infection. Antigen detection tests are also direct diagnostic methods, with the advantage of obtaining the result in a few minutes and at the very “pointof-care”. Furthermore, the simplicity and low cost of these tests allow them to be repeated on successive days in certain clinical settings. The sensitivity of antigen tests is generally lower than that of nucleic acid tests, although their specificity is comparable. Antigenic tests have been shown to be more valid in the days around the onset of symptoms, when the viral load in the nasopharynx is higher. Having a rapid and real-time viral detection assay such as the antigen test has been shown to be more useful to control the spread of the infection than more sensitive tests, but with greater cost and response time, such as in case of molecular tests. The main health institutions such as the WHO, the CDC and the Ministry of Health of the Government of Spain propose the use of antigenic tests in a wide variety of strategies to respond to the pandemic. This document aims to support physicians involved in the care of patients with suspected SC2 infection, in the context of a growing incidence in Spain since September 2020, which already represents the second pandemic wave of COVID-19.

Rev Esp Quimioter 2020; October 19 [Full-text PDF ENGLISH] [Texto completo PDF – ESPAÑOL]


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Rev Esp Quimioter 2020; October 16

Infections by OXA-48 carbapenemase-producing Enterobacteriaceae in surgical patients: antibiotic consumption and susceptibility patterns

ISMAEL MORA-GUZMÁN, IRENE RUBIO-PEREZ, DIEGO DOMINGO-GARCIA, ELENA MARTÍN-PÉREZ

Published: 16 October 2020

http://www.doi.org/10.37201/req/081.2020

Objective. To assess antibiotic consumption, susceptibility patterns and targeted treatment for OXA-48 carbapenemase-producing Enterobacteriaceae (CPE) related infections in surgical patients in a General Surgery Department.
Material and methods. Retrospective review of patients with a positive culture for OXA-48 and associated clinical data of infection, while hospitalized in a General Surgery Department from January 2013 to December 2018.
Results. Sixty-five patients with 66 isolations (OXA-48) were included: Klebsiella pneumoniae, 57 (86.5%); Enterobacter cloacae, 5 (7.6%); Escherichia coli, 3 (4.5%); Morganella morganii, 1 (1.5%). The most frequent source was intra-abdominal infection (n=39, 60%), and previous antibiotic consumption was: piperacillin-tazobactam (48%), meropenem (45%), ciprofloxacin (25.5%), ertapenem (16.5%), imipenem (12%), amikacin (12%), tigecycline (12%). Temporal trends (2013/14, 2015/16 and 2017/18) in susceptibility patterns were (percentages): ceftazidime-avibactam X-X-100; amikacin 100- 96-84 (p=0.518); tigecycline 100-92-80 (p=0.437); colistin 100-67-66 (p<0.001); meropenem 37-64-72 (p=0.214); imipenem 51-41-77 (p=0.109); gentamicin 13-19-18 (p=0.879); ertapenem 35-0-0 (p<0.001). Median duration of the targeted antibiotic therapy was 14 [IQR 9-20] days; antibiotics used were: tigecycline (57%); meropenem (40.5%); amikacin (37.5%); ceftazidime-avibactam (9%); imipenem (7.5%); colistin (7.5%). Global mortality rate at 30 days was 12% (8 patients). Targeted treatment was appropriate (antibiogram) in 87.7%, and targeted combination scheme was administered in 76.9%, which included a carbapenem in 49.2%.
Conclusions. OXA-48-related-intra-abdominal infection is significant in surgical patients, with substantial broad-spectrum antibiotic consumption. Useful targeted therapy includes ceftazidime-avibactam, amikacin, tigecycline, meropenem, and imipenem.

Rev Esp Quimioter 2020; October 16 [Texto completo PDF]


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Rev Esp Quimioter 2020; October 13

Impact of surgery on the mortality of infective endocarditis in a hospital without cardiac surgery

ROSA ESCUDERO-SÁNCHEZ, S. SCARLETH MENDOZA, LIZARDO, ELENA BATLLE LÓPEZ, CAROLINA CAMPELO GUTIERREZ, JUAN EMILIO LOSA GARCÍA, MARÍA VELASCO ARRIBAS

Published: 13 October 2020

http://www.doi.org/10.37201/req/005.2020

Background. Infective endocarditis has a high morbidity and mortality and requires a coordinated medical-surgical management. The objective was to analyse the impact of surgery on mortality in a hospital without cardiac surgery.
Material and methods. Evaluation of a prospective cohort of patients with infective endocarditis diagnosed between August 2011 and January 2016 according to modified Duke’s criteria.
Results. Sixty-four patients were included, of whom seventeen patients were operated (26.6%). Mortality was 32.8% and it was associated with chronic obstructive pulmonary disease history, staphylococci coagulase-negative and the appearance of complications, as valvular insufficiency and embolisms in the central nervous system; cardiac surgery was not associated with mortality. Four patients (6,6%) were not operated despite indication of cardiac surgery. The main reason for not been intervened was the poor presurgical prognosis (44.7%).
Conclusions. Mortality due to infective endocarditis in a hospital without cardiac surgery is high. The need for interhospital teams is strengthened.

Rev Esp Quimioter 2020; October 13 [Texto completo PDF]


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Rev Esp Quimioter 2020; September 22

Description of Influenza B in seasonal epidemic in Cantabria during the beginning of the pandemia due to SARS-CoV-2

DANIEL PABLO-MARCOS, ANA RODRÍGUEZ-FERNÁNDEZ, MÓNICA GOZALO, JESÚS AGÜERO, FRANCISCO ARNAIZ DE LAS REVILLAS, JORGE CALVO

Published: 22 September 2020

http://www.doi.org/10.37201/req/077.2020

Introduction. Co-circulation of the two Influenza B lineages hinders forecast of strain to include in trivalent vaccine. Autonomous Communities such as Cantabria continue without supplying tetravalent vaccine. The aim of this study was to analyse epidemiological characteristics of influenza type B in Cantabria (2019-2020 season) as well as to establish the predominant lineage and its relation to the recommended vaccine.
Methods. Retrospective study whereby flu diagnosis and lineage analysis were determined by RT-PCR.
Results. All samples belonged to the Victoria lineage. Most prevalent viral co-infection was due to SARS-CoV-2. The population affected by influenza B was mainly paediatric and non-vaccinated patients more frequently required hospital admittance.
Conclusions. Influenza type B has a higher incidence in the paediatric population and type A affects more the adult population. Only 28.8% of patients with Influenza B that presented with some underlying condition or risk factor were vaccinated. This shows the need to increase coverage with tetravalent vaccines in order to reduce the burden of disease associated with the Influenza B virus.

Rev Esp Quimioter 2020; September 22 [Texto completo PDF]


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Rev Esp Quimioter 2020; September 18

SARS-CoV-2 screening of asymptomatic women admitted for delivery must be performed with a combination of microbiological techniques: an observational study

MARIA CARMEN VIÑUELA, JUAN ANTONIO DE LEÓN-LUIS, ROBERTO ALONSO, PILAR CATALÁN, SANTIAGO LIZARRAGA, PATRICIA MUÑOZ, EMILIO BOUZA, ON BEHALF OF THE GREGORIO MARAÑÓN OBSTETRICS AND GYNECOLOGY AND MICROBIOLOGY-ID COVID 19 STUDY GROUP

Published: 18 September 2020

http://www.doi.org/10.37201/req/088.2020

Introduction. The aim of this study is to assess the value of systematic screening in asymptomatic women admitted for spontaneous delivery with a combination of reverse transcription polymerase chain reaction (RT-PCR) and cycle threshold (Ct) and serum antibodies.
Material and methods. Since May 6 all women admitted for spontaneous delivery underwent RT-PCR in nasopharyngeal swabs and specific antibodies IgG of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) in serum that were performed as part of routine clinical care in our institution. Ct of the PCR was recorded. We analyzed the first 100 women consecutively admitted for spontaneous delivery at our institution.
Results. Nine women were positive for SARS-CoV-2 in nasopharyngeal samples (9%) and 13 (13%) presented positive specific antibodies of the coronavirus. Overall, SARS-CoV-2 prior exposure was 15%. The Ct determination (RT-PCR test)
of our 9 positive patients ranged from 36 to 41 cycles with a median of 40. Vaginal delivery occurred in 94% of the cases and only 6% underwent a cesarean section, always for obstetric reasons. No fetal transmission was observed and maternal and neonatal prognosis was excellent.
Conclusions. During epidemic episodes in asymptomatic women in labor, universal testing with RT-PCR (considering Ct determination), and the detection of antibodies, permits a better interpretation of the results and avoid unnecessary isolation procedures.

Rev Esp Quimioter 2020; September 18 [Full-text PDF]


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Rev Esp Quimioter 2020; September 16

Analysis of the demand for detection of SARSCoV-2 in a health area of Spain

JESÚS GARCÍA-CRUCES, RAÚL LÓPEZ IZQUIERDO, MARTA DOMÍNGUEZ-GIL, LUIS LÓPEZ-URRUTIA, MÓNICA DE FRUTOS, BELÉN LORENZO, BEGOÑA NOGUEIRA, ANTONIO PUERTA, MARTA FERNÁNDEZ-ESGUEVA, IRENE MERINO, MARÍA CARMEN RAMOS-SANCHEZ, JOSÉ MARÍA EIROS

Published: 16 September 2020

http://www.doi.org/10.37201/req/089.2020

Introduction. Since the discovery of the SARS-CoV-2 virus, the polymerase chain reaction technique (RT-PCR) has become the fundamental method for diagnosing the disease in its acute phase. The objective is to describe the demand-based series of RT-PCR determinations received at a Microbiology Service at a third-level reference hospital for a health area for three months spanning from the onset of the epidemic by SARS-CoV-2.
Methods. A retrospective analysis of the total of the RT-PCR requested in the Microbiology Service analyzed from 02/25/2020 to 05/26/2020 (90 days) has been carried out. They have been grouped by epidemiological weeks and by the petitioner service. A descriptive analysis was carried out by age, gender and number of requests for each patient. In the tests carried out, a confidence level of 95% (p <0.05) was considered significant.
Results. A total of 27,106 requests was received corresponding to 22,037 patients. Median age 53.7 (RIC 40.9-71.7) years, women: 61.3%. Proportion of patients with any positive RT-PCR: 14%. Of the total requests for RT-PCR, positive 3,710. Week 13 had the highest diagnosis performance (39.0%). The primary care has been the service thar has made the most requests (15,953). Patients with 3 or more RT-PCR: 565, of them, 19 patients had a positive result after previously having a negative one.
Conclusions. Requests have been increasing depending on the evolution of the epidemic. The RT-PCR has a high diagnostic performance in the phases of highest contagiousness and / or transmissibility of the virus.

Rev Esp Quimioter 2020; September 16 [Texto completo PDF]


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Rev Esp Quimioter 2020; September 11

Immunity against SARS-CoV-2: walking to the vaccination

CARMEN RODRÍGUEZ HERNÁNDEZ, JUAN CARLOS SANZ MORENO

Published: 11 September 2020

http://www.doi.org/10.37201/req/086.2020

The coronavirus are a wide group of viruses among that the SARS-CoV-2 is included (family Coronaviridae, subfamily Coronavirinae, genus Betacoronavirus and subgenus Sarbecovirus). Its main structural proteins are the membrane (M), the envelope (E), the nucleocapsid (N) and spike (S). The immune response to SARS-CoV-2 involves the cellular and the humoral sides, with neutralizing antibodies fundamentally directed against the S antigen. Although the seroprevalence data are frequently assumed as protection markers, no necessarily they are. In Spain, it is estimated that, to assure the herd immunity, at least four-fifths of the population should be immunoprotected. Due the high fatality rate of COVID-19, the acquisition of the protection only by the natural infection it not assumable and other measures as the mass immunization are required. Currently, there are several vaccine prototypes (including life virus, viral vectors, peptides and proteins and nucleic acid) in different phase of clinical evaluation. Foreseeably, some of these news vaccines would be soon commercially available. In this text, aspects related to these issues are reviewed.

Rev Esp Quimioter 2020; September 11 [Texto completo PDF]


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Rev Esp Quimioter 2020; September 11

Repetition of microbiological tests in suspect of SARS-CoV-2 infection: utility of a score based on clinical probability

JAVIER PARDO LLEDIAS, LAURA AYARZA, PABLO GONZÁLEZ-GARCÍA, ZAIDA SALMÓN GONZÁLEZ, JORGE CALVO MONTES, MÓNICA GOZALO MARGUELLO, JOSÉ LUIS HERNÁNDEZ HERNÁNDEZ, JOSÉ MANUEL OLMOS MARTÍNEZ

Published: 11 September 2020

http://www.doi.org/10.37201/req/080.2020

Background. The diagnosis of SARS-CoV-2 infection presents some limitations. RT-PCR in nasopharyngeal swabs is considered the gold standard for the diagnosis, although it can have false negative results. We aimed to analyze the accuracy of repeating nasopharyngeal swabs based on different clinical probabilities.
Methods. Retrospective observational study of the first patients admitted to a two COVID Internal Medicine wards at the University Hospital Marqués de Valdecilla, Santander, from March to April 2020. RT-PCR targering E, N, RdRP and ORFab1 genes and antibody tests detecting IgG.
Results. A total of 145 hospitalized patients with suspected SARS-Cov2 infection were admitted and in 98 (67.5%) diagnosis was confirmed. The independent predictive variables for SARS-CoV-2 infection were: epidemiological contact, clinical presentation as pneumonia, absence of pneumonia in the last year, onset of symptoms > 7 days, two or more of the following symptoms -dyspnea, cough or fever- and serum lactate dehydrogenase levels >350 U/L (p<0.05). A score based on these variables yielded an AUC-ROC of 0.89 (CI95%, 0.831-0.946; p<0.001). The accuracy of the first nasopharyngeal swabs was 54.9%. Repeating nasopharyngeal swabs two or three times allows to detect an additional 16% of positive cases. The overall accuracy of successive RT-PCR tests in patients with low pre-test probability was <5%.
Conclusions. We have defined a pre-test probability score based on epidemiological and clinical data with a high accuracy for diagnosis of SARS-CoV-2. Repeating nasopharyngeal swabs avoids sampling errors, but only in medium of high probability pre-test clinical scenarios.

Rev Esp Quimioter 2020; September 11 [Texto completo PDF]


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Rev Esp Quimioter 2020; September 10

Importancia de los resultados de los hemocultivos: especial atención para los solicitados desde los Servicios de Urgencias   

(Importance of blood cultures results: and special attention for applicants from the Emergency Departament)

RAFAEL RUBIO DÍAZ, ISABEL NIETO ROJAS, AGUSTÍN JULIÁN-JIMÉNEZ

Published: 10 September 2020

http://www.doi.org/10.37201/req/075.2020

LETTER TO THE EDITOR

Rev Esp Quimioter 2020; September 10 [Texto completo PDF]


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Rev Esp Quimioter 2020; 33(5): 327-349

The situation of infection in the elderly in Spain: a multidisciplinary opinion document

EMILIO BOUZA, FRANCISCO JOSÉ BRENES, JAVIER DÍEZ DOMINGO, JOSÉ MARÍA EIROS BOUZA, JOSÉ GONZÁLEZ, DIEGO GRACIA, RICARDO JUÁREZ GONZÁLEZ, PATRICIA MUÑOZ, ROBERTO PETIDIER TORREGROSSA, JOSÉ MANUEL RIBERA CASADO, PRIMITIVO RAMOS CORDERO, EDUARDO RODRÍGUEZ ROVIRA, MARÍA EVA SÁEZ TORRALBA, JOSÉ ANTONIO SERRA REXACH, JAVIER TOVAR GARCÍA, CARLOS VERDEJO BRAVO, ESTEBAN PALOMO

Published: 8 September 2020

http://www.doi.org/10.37201/req/057.2020

Infection in the elderly is a huge issue whose treatment usually has partial and specific approaches. It is, moreover, one of the areas where intervention can have the most success in improving the quality of life of older patients. In an attempt to give the widest possible focus to this issue, the Health Sciences Foundation has convened experts from different areas to produce this position paper on Infection in the Elderly, so as to compare the opinions of expert doctors and nurses, pharmacists, journalists, representatives of elderly associations and concluding with the ethical aspects raised by the issue. The format is that of discussion of a series of pre-formulated questions that were discussed by all those present. We begin by discussing the concept of the elderly, the reasons for their predisposition to infection, the most frequent infections and their causes, and the workload and economic burden they place on society. We also considered whether we had the data to estimate the proportion of these infections that could be reduced by specific programmes, including vaccination programmes. In this context, the limited presence of this issue in the media, the position of scientific societies and patient associations on the issue and the ethical aspects raised by all this were discussed.

Rev Esp Quimioter 2020; 33(5): 327-349 [Full-text PDF]