A day in Spanish microbiology. Descriptive study of the activity of the clinical microbiology departments

J. Prieto ,  J. Á. García Rodríguez ,  J. Barberán ,  J. J. Granizo ,  M. P. Rodicio ,  J. González     

Introduction. The laboratory is an essential part of the work in the Clinical Microbiology Department. This study has aimed to measure the activity of these laboratories.

Material and methods. A survey was self-administered on the activity occurring during one work day by each hospital in October 2007.

Results. Thirty six hospitals reported 14,076 tests. Serology was the most frequently reported test (30.3%) followed by urine culture (27.8 %), blood tests (13.2 %), respiratory tract samples (8%), feces (7.1%), urethral (5.8%), skin (5.3%) and cerebrospinal fluid (2.6%). According to species, 73.2% of the isolates were bacteria (22.9 % were positive), 8.9% were virus (17% positive), fungi 8.1% (25.2% positive), and 5.5% mycobacterias (5.9% were positive) and parasite 4.5% (12.5% positive). Susceptibility test were performed by automatic methods (62.3%) followed by diffusion test (27.1%) and E-test (9.1%). A total of 5.6% of the susceptibility tests showed in vitro resistance to antibiotics. Fungi were identified in 108 isolates. Candida and Aspergillus were the most frequent genus (85.1% and 8.3%, respectively). Origins of the samples were: lower respiratory tract (32.4 %), genital tract (24.1 %), urine (10.2 %), blood (10.2 %) and skin (10.2 %). Twelve identification techniques were used, the most frequent being the morphological test (54.8%) and biochemical test (39.7%). Broken down by departments, 20.4% were sent from the ICU, 16.7% from surgery, 29.6% from medicine and 18.5% from primary care.

Discussion. Although the workload of the laboratories has been measured in this work, aspects such as specimen manipulation, clinical advice and research were not considered.

  

Key words: Laboratory. Fungi. Activity. Assistance. Organization.

Rev Esp Quimioter 2008;21(4):206-212 [pdf]  

Antimicrobial drugs errors: the silent epidemic in patient safety

M. D. Menéndez Fraga ,  J. J. Corte García ,  M. Alonso Álvarez ,  M. Espín Fernández ,  J. Solano Jaurrieta. ,  F. Vázquez Valdés 

  

Introduction. Prescribed drugs and the mistakes in the administration to patient is the first cause of adverse events in the hospitals. The aim of this study has been to evaluate antimicrobial drug mistakes in one of our hospital wards in a two year period 2005 and 2006.

Methods. All the errors were reported through the National Health Service IR2 form (England) on a voluntary basis and classified by means of process, type of errors, their causes and contributory factors, as well as the severity. We analyzed the economic costs.    

Results. A 1.3% of the inpatients had an antimicrobial error in the administration to the patient (0.84 by 1,000 prescribing orders). Classified by processes, the administration (32.4%) and dispensation (44.1%) were the most frequent errors. By type of error: the erroneous medication (32.4%), the main root cause the human factors (58.8 %) and the contribution factor due to design of tasks (55.9 %). The 5.9% of errors were severe events, mainly in the group of the betalactamic drugs, and mainly by parenteral administration (50%).

Conclusions. Antimicrobial drug errors, frequent and sometimes severe, suppose a silent epidemic not being detected without the patient safety methodology. They represent a high cost for a hospital.

  

Key words: Medication errors. Antimicrobial drugs. Patient safety.

Rev Esp Quimioter 2008;21(3):194-197 [pdf]   

Comparison between Phoenix system and agar-based methods for antimicrobial susceptibility testing of Streptococcus spp

L. Martínez-Lamas ,  M. Treviño Castellano ,  P. A. Romero-Jung ,  B. J. Regueiro García 

  

Introduction. Antibiotic resistance is an emerging problem among streptococcal species, especially for severe infections. Automated diagnostic systems for antimicrobial susceptibility testing, such as BD Phoenix, is a recently available instruments that makes it possible to obtain results within 12 h.

Methods. Antimicrobial susceptibility testing results of the BD Phoenix system were compared to those obtained from Clinical Laboratory Standards Institute (CLSI) disk-diffusion method. Two-hundred different clinical isolates of streptococci were assayed: beta-hemolytic (n=65), viridans (n=87), S. penumoniae (n=48).

Results. Overall, there was categorical agreement greater than 96.7% (94.8% for beta-hemolytic and 97.9% for viridans group) in relationship to the disk-diffusion method. The minor error rates were less than 10% for all the antibiotics. The greatest percentage of serious errors corresponded to erythromycin and clindamycin within the beta-hemolytic group (14.7%). Overall percentage of very serious errors was less 0.5%. The results for penicillin in viridans streptococci and S. pneumoniae results showed 89.7% and 91.7% of categorical agreement, respectively, using the Etest as reference.

Conclusions. The automated BD Phoenix system is a very useful and effective diagnostic tool for quantitative testing of sensitivity to antibiotics in the streptococci group.

  

Key words: Streptococcus. Antimicrobial susceptibility testing. Phoenix. Disk-diffusion. ETest

Rev Esp Quimioter 2008;21(3):184-188 [pdf]      

Evaluation of marine sponge extracts as new sources of antimicrobial substances

J. A. Mora Cristancho ,  F. Newmark Umbreit ,  M. Santos-Acevedo ,  J. Sánchez Nieves 

  

As part of the search for new natural sources of antibiotic compounds, in this study, carried out in the northeastern coast of Colombia, 15 sponge species were collected. A crude organic extract was obtained from each in vitro against microorganisms with clinical importance for humans (one strain for each specie of Streptococcus faecalis, Staphylococcus aureus, Escherichia coli, Pseudomonas aeruginosa and Candida albicans). Sponge extracts from Halichondria spp., Petromica ciocalyptoides and Xestospongia proxima exhibited antibacterial activity against gram-positive bacteria and antifungal activity against the fungi, while the sponge Dragmacidon reticulata showed activity only for the same yeast specie. Bioactivity of the extracts was compared with that of both a antibiotic (cefoperazone) and an antimicotic (nistatine). It was found that inhibition values of X. proxima extracts in vitro are, in some cases, higher than those observed for cefoperazone and nistatine. Crude extracts from the sponges Myrmekioderma gyroderma, Myrmekioderma rea, Biemna cribaria, Cinachyrella kuekenthali, Iotrochota imminuta, Oceanapia peltata, Polymastia tenax, Desmapsamma anchorata, Spirastrella coccinea, Cribrochalina infundibulum and Oceanapia bartschi did not show any antimicrobial activity whatsoever.

 

Key words: Porifera. Antimicrobial. Crude extracts. Marine bioprospecting. Colombian Caribbean.

 

Rev Esp Quimioter 2008;21(3):174-179 [pdf] 

Distribution of patterns of sensitivity and associated phenotypes of resistance in nosocomial and community acquired Escherichia coli during 2005

M. V. García López ,  M. M. Gallardo García ,  R. Rodríguez-Ortega ,  F. Ropero Pinto ,  E. Granados Martín ,  M. I. Viciana Ramos ,  A. Gutiérrez-Cobos ,  A. Pinedo Sánchez

  

Introduction. The increase of resistances to Escherichia coli over recent years has made it necessary to know the patterns of sensitivity in a certain area in order to be able to orient adequate empirical treatment with this knowledge.

Method. Prospective longitudinal study using E. coli isolations obtained during year 2005 in the University Hospital Virgen de la Victoria was performed. Sensitivity identification and study were made according to standardized laboratory protocols.

Results. A total of 2,612 strains of E. coli were isolated from 2,098 patients with an average age of 52 years who had urinary infection as the most frequent sign. E. coli sensitivity was: ampicillin (AMP) (35.4%), ciprofloxacin (QUIN) (67.3 %), trimethoprim-sulfametoxazole (SXT) (63.4 %), phosphomycin (97.2 %) and amoxicillin-clavulanic acid (89%). The percentage of E. coli extended-spectrum β-lactamase (ESBL) producers was 8.2%. In general, nosocomial isolations were more resistant, this difference being significant for third generation cephalosporins, gentamicin and piperacillin/tazobactam (p < 0.005). Resistance in men was greater than in women and also in adults compared to children, with significant differences to ciprofloxacin and gentamicin (p < 0.005). A total of 27.5% of the strains were multiresistant, the most frequent phenotype being the one to AMP/SXT (11.9%), followed by AMP/QUIN/SXT (10.9%).

Conclusions. Resistances to E. coli are very elevated in out setting, above all, in quinolones, that even appear in children, so that up to half of the multiresistant phenotypes present resistance to this family. Furthermore, during the last year, an increase in the isolations of E. coli ESBL producers has been observed.

Key words: Escherichia coli. Phenotype of resistance. Antibiotic sensitivity. ESBL.

Rev Esp Quimioter 2008;21(3):157-165 [pdf]