Rev Esp Quimioter 2009:22(3):151-172

Recommendations in the empiric anti-infective agents of intra-abdominal infection

X. Guirao ,  J. Arias ,  J. M.ª Badía ,  J. A. García-Rodríguez ,  J. Mensa ,  F. Álvarez-Lerma ,  M. Borges ,  J. Barberán ,  E. Maseda ,  M. Salavert ,  P. Llinares ,  M. Gobernado y C. García Rey 

  

A significant number of patients with abdominal infection develop advanced stages of infection and mortality is still above 20%. Failure is multifactorial and is associated with an increase of bacterial resistance, inappropriate empirical treatment, a higher comorbidity of patients and poor source control of infection. These guidelines discuss each of these problems and propose measures to avoid the failure based on the best current scientific evidence.

 

Key words: Intra-abdominal infection. Guidelines. Anti-infective agents

Rev Esp Quimioter 2009:22(3):151-172  [pdf]

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Rev Esp Quimioter 2009:22(3):144-150

Cefditoren and community-acquired lower respiratory tract infections

J. Barberán and J. Mensa 

  

Cefditoren is a third-generation oral cephalosporin with good activity against respiratory tract pathogens, including penicllin–intermediate and —resistant strains of S. pneumoniae, and β-lactamase producing strains of H. influenzae and M. catarrhalis. Its bacterial activity, measured by minimum inhibitory concentration (MIC), is similar or superior to that of many other commonly used antibiotics (penicillins, cephalosporins and fluoroquinolones). Considering the target attainment of T > MIC of ≥ 40% a more reliable predictor of clinical and microbiologic outcomes, cefditoren covers strains of S. pneumoniae with MIC values ≤ 0.5 μg/mL and ≤ 1 μg/mL in the case of doses of 200 mg and 400 mg, respectively, and all strains of H. influenzae. Cefditoren has been associated with high rates of bacteriologic response among the main causative pathogens in lower respiratory tract infection (~–85% against H. influenzae and ~–90% against S. pneumoniae, including penicillin-intermediate and penicillin-resistant strains). It is a reliable option for switch therapy in case of treatment with third-generation intravenous cephalosporin. Cefditoren is currently approved in Spain for the treatment of adults and adolescents with acute exacerbations of chronic bronchitis (AECB) and community-acquired pneumonia (CAP), two of the lower respiratory tract infections most commonly encountered in clinical practice.

 

Key words: Cefditoren. Respiratory tract infections. Haemophilus influenzae. Streptococcus pneumoniae.

Rev Esp Quimioter 2009:22(3):144-150 [texto completo ESPAÑOL] [full text ENGLISH]

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Rev Esp Quimioter 2009:22(3):139-143

In vitro activities of posaconazole, fluconazole, itraconazole, ketoconazole and voriconazole against Candida glabrata

M. T. Blanco ,  J. Cañadas ,  P. García-Martos ,  P. Marín. ,  A. García-Tapia ,  M.J. Rodríguez 

  

This study has been conducted to asses the in vitro activity of the novel triazole antifungal agent posaconazole against 123 clinically important isolates of yeasts. Susceptibility was tested using the Sensititre YeastOne microdilution commercial method. Minimun inhibitory concentrations (MICs) were determined at the recommended endpoints and time intervals. The activity of posaconazole against Candida glabrata was compared with those of fluconazole, itraconazole, ketoconazole and voriconazole. The most susceptible species to posaconazole were C. albicans, C. parapsilosis, C. tropicalis and C. dubliniensis. Candida glabrata was the least susceptible. The percentage of strains with MIC for posaconazole ≥ 1 mg/L was 9%, all of them were C. glabrata. The species with MIC for itraconazole ≥ 0.5 mg/L were 36% (41 C. glabrata, 1 C. krusei, 1 C. guilliermondii, 1 C. ciferrii). Candida glabrata strains resistant to fluconazole, ketoconazole and voriconazole were 8%, 4% and 4%, respectively. Posaconazole exhibited good activity to the majority of Candida species. However, it was similar to itraconazole and less active than ketoconazole and voriconazole against C. glabrata.

 

Key words: Posaconazole. Yeasts. Candida glabrata.

Rev Esp Quimioter 2009:22(3):139-143  [pdf]

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Rev Esp Quimioter 2009:22(3):135-138

Activity of Ertapenem and Ceftriaxone in the eradication of Salmonella in a model of experimental peritonitis in mice

F. S. Lozano ,  M. I. García ,  E. García ,  B. González ,  M. B. García ,  F. J. García y J. E. García 

  

Since the beginning of the 1990s, the prevalence of isolates of non-typhoidal Salmonella species resistant to antimicrobial agents, including those commonly used for the treatment of Salmonella infections such as fluoroquinolones, trimethoprim-sulfamethoxazole or â-lactams, has increased substantially. Infections caused by multidrugresistant strains of non-typhoidal Salmonella are now frequently encountered. In order to consider an appropriate role of Ertapenem in Salmonella-due intraabdominal infections, in the present study we compare the efficacy of Ertapenem versus that of Ceftriaxone in a mouse peritonitis model. Bacteriological eradication from blood, liver and mesenteric lymph nodes was observed after 5 and 7 days of treatment in all infected mice receiving ceftriaxone. Although both antimicrobial agents —Ertapenem and Ceftriaxone— were observed to be effective in reducing mortality in inoculated mice, our data suggests a reduced efficacy of Ertapenem in the bacteriological eradication of Salmonella enterica serotype Typhimurium in a mouse peritonitis model.

  

Key words: Ceftriaxone. Ertapenem. Bacteriological eradication. Experimental peritonitis. 

Rev Esp Quimioter 2009:22(3):135-138 [pdf]

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Rev Esp Quimioter 2009:22(3):120-126

Antimicrobial susceptibility and molecular typing of Enterococcus faecium idolated from humans, chickens and environment in Canary Islands (Spain)

M. González ,  O. Afonso y M. T. Tejedor 

  

Comparative studies on antimicrobial susceptibility patterns and molecular typing of Enterococcus isolates of different origins provides valuable information concerning the epidemiology of enterococcal infections. We analyzed clinical isolates and we surveyed faecal samples of humans (hospitalised patients and healthy volunteers), faecal samples of poultry and environmental samples. A total of 68 E. faecium isolates were obtained: 43 from humans, 5 from poultry and 20 from water. We compared the antibiotic resistance patterns and pulsed field gel electrophoresis (PFGE) profiles of these strains. We used polymerase chain reaction (PCR) to examine them for the presence of 8 aminoglycoside resistance genes. Differences among percentages of antimicrobial resistance between clinical and non clinical isolates were found. All enterococci were susceptible to vancomycin and teicoplanin. Four aminoglycoside resistance genes were detected, most frequently ant(6)-Ia and aph(3’)-IIIa. Presence of isolates resistant to gentamicin but negative for all genes tested suggest that additional resistance genes may exist. VRE are still rare inside and outside hospitals in Gran Canaria (Spain). The high frequency of ampicillin resistance among clinical enterococci and the fact that several isolates share the same PFGE type were isolated from different wards of our hospital suggest that ampicillinresistant E. faecium are endemic in our Hospital.

 

Key words:Antimicrobial resistance. E. faecium. Polymerase chain reaction (PCR). Pulsed field gel electrophoresis(PFGE).

Rev Esp Quimioter 2009:22(3):120-126  [pdf]  

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Rev Esp Quimioter 2009:22(3):117-119

Investigation of Enterococcus faecalis antimicrobial resistance

M. M. Casal ,  M. Causse ,  F. Solis ,  F. Rodríguez y M. Casal 

  

We performed an antibiotic resistance study on Enterococcus faecalis isolated from intrahospitalary and extrahospitalary samples between january 2004 and january 2008. Three different samples were studied; urine, blood and wound swabs, considering a strain per patient. We included in the study a global amount of 3,641 Enterococcus faecalis isolations from clinical samples received at Hospital Universitario Reina Sofía microbiology service in Córdoba (Spain). We employed semiautomatic system WIDER I (Soria Melguizo) for identification and sensibility testing. We considered sensibility and resistance criteria recommended by MENSURA group. We found a sensitivity rate of 98.04% to betalactamics.The highest resistance rates were obtained with aminoglycosides, between 33.82% and 48.01%. Linezolid and Vancomycin sensitivity was 100%. It seems that vancomycin resistance is not a worrying issue today, but it should be controlled.

  

Key words: Enterococcus faecalis. Resistance. Antimicrobial agents.

Rev Esp Quimioter 2009:22(3):117-119   [pdf] 

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Rev Esp Quimioter 2009:22(2):106-114

Tinidazole: a classical anaerobical drug with multiple potential uses nowadays

J. J. Granizo, M. P. Rodicio ,  F. J. Manso y M. J. Giménez 

  

Tinidazole is a 5-nitroimidazole active in vitro against a wide variety of anaerobic bacteria and protozoa. Tinidazole is an effective treatment against anaerobic microorganisms based on its pharmacokinetic characteristics (Cmáx 51 μg/ml, t½ 12.5 h) and its excellent in vitro activity. Its long half-life allows once a day regimens. Tinidazole is as effective as metronidazole in the treatment of infections caused by T. vaginalis, giardiasis and amebiasis and bacterial vaginosis, malaria, odontogenic infections, anaerobic bacterial infections (pelvic inflammatory disease, diabetic foot), surgical prophylaxis (abdominal and hysterectomy) and Helicobacter pylori eradication. Tinidazole was recently approved by the Food and Drug Administration (FDA) for the treatment of infections caused by Trichomonas vaginalis, Entamoeba histolytica and Giardia lamblia.

 

Keywords: Tinidazol. Pharmacodynamia. Pharmacokinetics. Anaerobes. Helicobacter

Rev Esp Quimioter 2009:22(2):106-114   [pdf]

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Rev Esp Quimioter 2009:22(2):93-105

Antiparasitic drugs. Review of the useful drugs in the treatment of clasic and emergent parasitic diseases

J.L. Pérez,  C. Carranza y F. Mateos J.-L. Pérez ,  C. Carranza y F. Mateos 

  

Source. Critical review of the litterature.

Structure. Firstly, several general considerations were made on the antiparasitic drugs revised in this paper. Chemical structures and mechanisms of action of the main drugs with antiparasitic effect were considered in the second part of the review. Further, antiparasitic spectrum of selected drugs, main pharmacokinetical characteristics, usual posology, possible side effects and contraindications were detailed. Finally, some practical aspects, such as interactions and the methods for practical obtention of these drugs are indicated. This information is relevant because in Spain many anti-parasitic drugs may be obtained using non conventional methods.

Conclusion. In Spain, the increase of parasitic diseases it does necessary an update on antiparasitics drugs for their treatment.

  

Key words: Antiparasitic drugs. Mechanism of action. Spectrum. Pharmacokinetics. Side effects.

Rev Esp Quimioter 2009:22(2):93-105  [pdf] 

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Rev Esp Quimioter 2009:22(2):88-92

High percentage of clarithromycin and metronidazole resistance in Helicobacter pylori clinical isolates obtained from Spanish children

S. Agudo ,  T. Alarcón ,  L. Cibrelus ,  P. Urruzuno ,  M. J. Martínez y M. López-Brea 

  

Objective.To determine the primary and secondary resistance to several antimicrobial agents in Spanish Helicobacter pylori clinical isolates obtained from paediatric patients from January 2002 to June 2006.

Methods.Samples were collected from gastric biopsies of symptomatic paediatric patients and H. pylori cultured according to standard microbiological procedures. Resistance was determined by E-test. Strains were considered resistant if minimal inhibitory concentration (MIC) ≥ 2 mg/l for amoxycillin, ≥4 mg/l for tetracycline, ≥ 8 mg/l for metronidazole, ≥ 1 mg/l for clarithromycin, MIC ≥ 4 mg/l for ciprofloxacin, MIC  ≥32 mg/l for rifampicin and intermediate if MIC = 0.5 mg/l for clarithromycin, and MIC = 2 mg/l for ciprofloxacin.

Results. A total of 101 patients were included: 38 males and 63 females (sex ratio M/F: 0.6). Average age was 10 years (range: 4-18 years). All strains were susceptible to amoxycillin, tetracycline and rifampicin, 35.7% were resistant to metronidazole, 54.6% to clarithromycin and 1.8% to ciprofloxacin. 2.0% were intermediate to clarithromycin and 1.8% to ciprofloxacin. Double resistance to metronidazole and clarithromycin rated at 17.2%. Thirty-five patients (34.7%) had a history of treatment failure, and were considered as secondary H. pylori. Primary resistance rates to metronidazole and clarithromycin were 32.8% and 49.2%, respectively, and secondary resistance rates were 41.2% and 70.6%, respectively.

Conclusions. Resistance to clarithromycin (56.6%) was higher than to metronidazole (35.7%) in the H. pylori strains studied. Clarithromycin resistance was very high even in strains from paediatric patients not previously treated for H. pylori infection.

  

Keywords: Primary resistance. Paediatrics. Ciprofloxacin. Rifampicin. Treatment failure.

Rev Esp Quimioter 2009:22(2):88-92 [pdf] 

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Rev Esp Quimioter 2009:22(2):83-87

Diagnosis of urethritis in men. A 3 years review

M. Á. Orellana ,  M.L. Gómez-Lus ,  M. Teresa Sánchez y T. Fernández-Chacón 

  

Objetives. The aim of this study is to know the prevalence and tendency of microorganisms producing urethritis, in men, in the City Centre of Madrid.

Methods. Cross-sectional study. The urethral samples of 1.248 men were analyzed, for 3 years. The samples were studied for: GRAM stain, when secretion exists; culture in habitual plates; detection of C. trachomatis, U. urealyticum and M. hominis, when there was suspicious, study of T. vaginalis and when suspicious injuries exist, study of virus Herpes simplex.

Results. The percentage of positive samples was 22.60%. The isolated microorganisms were: U. urealyticum 7.61%, N. gonorrhoeae 6.33%, C. trachomatis 4.81%, M. hominis 0.24%, H. parainfluenzae 1.76%, H. influenzae 1.12%, Candida spp 0.48%, S. pyogenes 0.16% and Herpes virus simplex (2) 0.08%. Two or more microorganisms were isolated in 1.68%. The percentage of positive samples in 2003 was 17.41% and N. gonorrhoeae the most frequent microorganism (6.22%). In 2004 was 25.57% and the most frequent U. urealyticum (10.18%). In 2005 the 24.50% of the samples were positive and U. urealyticum the most frequent (7.92%). The 79.41% of N. gonorrhoeae were susceptible to all antibiotics tested. It is not found resistance to ceftriaxone, claritromicine and amoxicilline/clavulanic acid. The 11.76% were betalactamase- producing. The 26.47% of Haemophilus spp. were betalactamase- producing and all strains were susceptible to cefotaxime.

Conclusions. The isolated microorganisms most frequently were: U. urealyticum, N. gonorrhoeae and C. trachomatis. There is an increase of 7% of prevalence between the years 2003 and 2005. Ceftriaxone, claritromicine and amoxicilline/clavulanic acid were susceptible to all the strains studied and cefotaxime to all Haemophilus spp.

  

Key words: Urethritis. Sexually transmitted disease. Prevalence.

Rev Esp Quimioter 2009:22(2):83-87 [pdf]

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