Rev Esp Quimioter 2009:22(2):76-82

Multicenter study of in vitro activity of tigecycline in clinical isolates from 30 centers in Spain

J. A. García-Rodríguez y Grupo de Estudio de Sensibilidad Antibiótica 

  

Introduction. In the last years, the increase of antibiotic resistances of grampositive and gramnegative bacteria is an important therapeutic problem. The antimicrobial activity of tigecycline, a novel glycylcycline, was evaluated against 750 bacterial isolates from 30 centers in Spain.

Methods. Multicenter and retrospective study. In 2005, thirty laboratories participated in this study. Data collected in this study included antimicrobial susceptibilities for S.aureus resistant to methicillin (MRSA), ESBL- E. coli or ESBL- K. pneumoniae, E. coli resistant to quinolons (E.coli– QR), Klebsiella spp and E. faecalis. Trains were obtained of the each Hospital´s collection (5 strains of each microorganisms). The susceptibility determinations were performed locally by each laboratory following the standard method usually performed. The tigecycline susceptibility determinations were performed with E/test.

Results. Tigecycline was the most potent agent against MRSA, E. faecalis, E.coli-QR and ESBLs enterobacteriaceae; with MIC50-MIC90 values of: 0.125-0.25 g/ml; 0.125-0.5 g/ml; 0.25-0.75 g/ml and 0.38-1.5 g/ml; respectively.

Conclusions. The results of this study confirm the excellent in vitro activity of tigecycline against gram-positive and gram-negative pathogens, including multirresistant microorganisms.

Key words: Multicenter study. Tigecycline.

Rev Esp Quimioter 2009:22(2):76-82 [pdf] 

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Rev Esp Quimioter 2009:22(2):68-75

Use of linezolid in critically ill patients admitted to Intensive Care Units

O. Rodríguez ,  F. Álvarez ,  E. Cereijo ,  M.M. Latorre ,  H. Martínez ,  Study Group for the Use of Active Antibiotics against Multiresistant Gram – Positive Cocci 

All indications of linezolid (LZD) in Intensive Care Units (ICU) were included as cases in an observational, prospective and multicentre study. One hundred thirty-nine indications were analyzed. In most cases (92.7%), treatment for nosocomial infections was indicated. The most frequent infection was pneumonia (42.7%), followed by catheter-related bacteraemias (CRB). A total of 58.7% of the indications were empirical and in 45.7% of the cases the cultures confirmed infection by grampositive cocci (GPC). In 43 cases (31.2%), the indication was made as a rescue measure (mainly due to clinical failure) in patients previously treated with glycopeptides. Of isolated GPC, 70.2% were methicillin-resistant. The cure rate of the population per intent-to-treat was 73.2%. Only one case of thrombocytopenia was recorded.  LZD is used with a high degree of diagnostic safety. In the ICU, it is primarily indicated to treat pneumonias and CRB with good clinical and microbiological response. This antibiotic has acted as a good therapeutic resource against clinical failure in infections treated with glycopeptides.

  

Keywords: Linezolid. Critically ill patient. ICU.

Rev Esp Quimioter 2009:22(2):68-75  [pdf]

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Rev Esp Quimioter 2009;22(2):62-67

Hydatid disease in Departament oh Health two of the Valencian Community (Spain)

J. Moreno ,  C. J. Téllez y F. J. Pardo 

  

Hydatidosis is one of the most important zoonotic parasitic diseases of Mediterranean and South American countries where they constitute a significant health problem. Its diagnosis is realized essentially by image techniques and its treatment continues being eminently surgical. During the period 2000-2005, we reviewed clinical records of diagnosed and treated cases of hydatidosis carried out at the Department of Health 2 of the Valencia Community, Spain. Thirty three cases were evaluated of which we describe demographic, radiological, clinical,analytic, therapeutical and evolutionary data. We discuss the peculiarities found in them: thirty two cases were of hepatic location, essentially right, 48.5% unique cysts, five casual finding, 88.87% were diagnosed by ultrasonographic technique and in 2/3 of the cases the serology was positive. In addition, 52.17% of the twenty three cases treated surgically cured without recurrence and a 15.15% recurred without subsequent healing. Studies will require long term monitoring of patients evolution.

 

Key words: Hydatidosis. Zoonotic parasitic diseases. Diagnosis and treatment.

Rev Esp Quimioter 2009;22(2):62-67  [pdf]  

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Rev Esp Quimioter 2009;22(2):57-61

Safety profile of cefditoren. A pooled analysis of data from clinical trials in community-acquired respiratory tract infections

J. J. Granizo ,  L. Aguilar ,  M. J. Giménez ,  P. Coronel ,  M. Gimeno y J. Prieto 

  

Introduction. A high number of individuals in the population are exposed to antibiotics for the treatment of respiratory tract infections. It is important to review the adverse events profile related to antibiotic exposure during the clinical development of drugs that are or have been recently included in the therapeutic armamentarium.

Material and methods. Safety data from all 13 clinical trials of cefditoren on community acquired respiratory infections were reviewed. Safety population was defined as all randomized patients with at least one dose intake. Adverse events considered by investigators as related during antibiotic exposure were considered.

Results. The overall safety population consisted in 4,592 patients for cefditoren and 2,784 for comparators. Overall reported diarrhoea related to cefditoren administration was significantly higher (p ¡Ü 0.001) than comparators (9.9% vs 6.9%) due to the significant difference in the pooled pharyngotonsillitis studies (8.3% vs 3.2%), while no significant differences in others pathologies were found, with 9.4% (with cefditoren) vs 10.3% (with comparators) in the case of community-acquired pneumonia (CAP). Dyspepsia and abdominal pain were reported as adverse events in < 2.7% patients regardless the treated disease. In females population lower related vaginosis rate was found in cefditoren vs comparators, mainly due to differences among patients treated for sinusitis (4.5% vs 8.1%) and CAP (2.3% vs 5.5%) although differences were not significant (p = 0.017 and p = 0.008, respectively).

Conclusion. This study analysing reported adverse events from clinical trials showed an adverse events profile of cefditoren similar to those of standard antibiotics used in the treatment of respiratory tract infections.

  

Keywords: Cefditoren. Safety. Clinical trials. Respiratory tract infections. Adverse events.

Rev Esp Quimioter 2009;22(2):57-61  [pdf]  

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Rev Esp Quimioter 2009;22(1):48-56

Clinical experience with tigecycline in the treatment of nosocomial infections caused by isolates exhibiting prevalent resistance mechanisms

 M. J. Giménez ,  C. García-Rey ,  J. Barberán y L. Aguilar     

This article reviews the clinical experience with tigecycline in the treatment of infections caused by microorganisms with prevalent resistance mechanisms among nosocomial microbiota, as methicillin-resistant Staphylococcus aureus, vancomycin-resistant enterococci, multidrug- resistant Acinetobacter baumannii and enterobacteria producing extended spectrum ß-lactamases. Most of articles found in the literature describe the use of tigecycline in the treatment of severe infections (sepsis and septic shock, nosocomial pneumonia and ventilador- associated pneumonia…) produced by multidrug-resistant microorganisms, in patients with multiple comorbidities (admitted in ICU, with malignancies, transplants and/or immunodepressed…) and in many occasions after failures of previous antibiotic treatments. Favourable outcomes with tigecycline are reported in most articles. However, an accurate global assessment is difficult since, in addition to the described confounding factors, there are concomitant or sequential antibiotic treatments in several communications, and lack of relevant clinical (as comorbidities), microbiological (as susceptibility) and outcome (different criteria by different authors) data in others. More even, the described series are retrospective and lack of control groups. Nevertheless the usefulness of this revision is based on the fact that in daily clinical practice the use of tigecycline will increase, since epidemiology of specific hospital medical units shows multidrug resistance among nosocomial isolates and tigecycline can be one of the scarce available compounds active against multidrug-resistant strains/clones.

 

Key words: Tigecycline. Nosocomial infections. Multidrug resistant.

Rev Esp Quimioter 2009;22(1):48-56 [pdf] 

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Rev Esp Quimioter 2009;22(1):38-47

Importance of the antimicrobial spectrum and the bacterial resistances in the antibiotic Choice for the treatment of pediatric patients with comunitary infections

F. Baquero ,  J. González ,  D. Martínez ,  V. Olmo ,  A. Orero y J. Prieto (Grupo MUSA) 

  

Objective. This study aimed to know the importance of the antimicrobial spectrum and the bacterial resistances for the antibiotic choice in the extrahospitalary pediatric area, at the same time that establish the relationship with others therapeutics parameters.

Material and methods. Cross-sectional, observational study within the MUSA (Improvement of Use of Antimicrobial Agents in Primary Health Care) Project made by personal interview of 210 pediatrician doctors randomly selected with national represantitivity. This target is included in a bigger universe (855 doctors) representative of the most doctors responsible of the antibiotic prescriptions in the extrahospitalary area (sample error of the 3,3 % for a 95 % confidence interval and maximum response dispersion: p=q=50). The results of the pediatric study were subjected to a comparative analysis with the results of a similar study made ten years ago and with the global results of the general study. The questionnaire used for the interview had two crearly differenced parts: in the first part, the questions were open with the objective to get spontanious answers from the participants; the second part had questions with suggested answers.

Results. Clinical efficacy is the most spontaneously valored issue by the spanish pediatricians when it comes to choosing an antimicrobial agent; efficacy is followed by tolerance/safety and posology. Antimicrobial spectrum is mentioned by one out of 4-5 pediatricians that have participated in the study (21,9%), while the bacterial resistances are only mentioned by a 3,8%. In a suggested level, clinical efficacy is still the most valued parameter, being identified by 7 out of 10 interviewed with the bacterial eradication. In this case, the antimicrobial spectrum is the following parameter on significance, appearing as a synonym of «activity against specific microorganisms» in 2 out of 3 cases. In relation to his own evaluation, 3 out of 4 pediatricians say they take «a lot» the bacterial resistences into consideration, who are mostly understood as «global rate» for 5-6 out of 10 interviewed, whether the resistence showed by the neumococo is what worried the most to 4 out of 10 of them. This importance given to the bacterial resistences at the second part of the study contrasts with the low consideration showed when it is compared eith other parameters and the valoration is treated in a spontaneous way.In relation to a similar study realized on 1997 (Urano Proyect), we observe that clinical efficacy has replaced tolerance/safety as a parameter to bear in mind, probably as a consequence of more experience and confidence with the most important antimicrobial agents in the antibiotic prescriptions in podiatry. On the other hand, the bacterial resistences still being left out on the pediatricians spontaneous consideration, a fact that is shared with the mayority of the collectives participating on the general study. The rest of the parameters stay in a similar way.

Conclusions. Is necessary to emphasize at the importance of bacterial resistences in the antimicrobials rational use on the pediatric patient. As the antimicrobial tolerance profile has been improving in the last ten years, clinical efficacy, understood as «bacterial eradication » has became the most determinating parameter when choosing antimicrobial agents.

  

Key words:Antimicrobials. Pediatry. Bacterial resistences. Antibiotic spectrum. Clinical efficacy.

Rev Esp Quimioter 2009;22(1):38-47   [pdf]

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Rev Esp Quimioter 2009;22(1):34-37

Viral Load in Spanish HIV patients: trends since the introduction of HAART

J. M.ª Eiros ,  E. Sánchez-Padilla ,  F. J. Luquero ,  B. Nogueira ,  S. Rojo ,  J. Atienza-Herrero y R. Ortiz de Lejarazu 

  

The aim of this study is to describe trends in the percentage of samples with undetectable HIV viral load in Spain after the implementation of HAART. A descriptive observational study of HIV-VL measurements carried out in the microbiology department of the Hospital Clínico Universitario de Valladolid (HCUV) was conducted over a 9-year period (1996-2004). Regarding the trend over the study period, the 30-39 years age group accounted for most of the samples, although the percentage decreased from 65.5 % to 59.6% over the study period. In contrast, the 40-49 years group increased from 9.1 % to 14.5 %. The preponderance of men, with percentages above 70 %, was observed during the whole period. Although the purpose of this treatment is to maintain undetectable viral loads, since 1999 more than 60% of nonfirst samples had detectable levels. Based on the results of the VL trend among HIV/AIDS patients observed in this study, a large number of patients maintain elevated detectable VL years after HAART was implemented. Although different factors may be the cause of this and should be delimited in future studies, the phenomenon observed demonstrates the usefulness of monitoring VL and analyzing its time trend to gain further knowledge about the therapeutic results and care of HIV patients as a whole, also serving as the basis for corrective measures.

  

Key words:HIV, Viral Load, HAART.

Rev Esp Quimioter 2009;22(1):34-37  [pdf] 

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Rev Esp Quimioter 2009;22(1):30-33

 

Resistant mutant prevention concentration of fluoroquinolones in clinical isolates of extended spectrum beta-lactamase (ESBL) producing and non-producing strains of Escherichia coli

O. Noguera ,  J. C. Rodríguez ,  J. M. López ,  M. Ruiz y G. Royo 

  

The aim of this job is to study the capacity of ciprofloxacin and levofloxacin in restricting the development of resistant mutants in strains of Escherichia coli by determining the mutant prevention concentration (MPC). Ninety-nine isolates of E. coli with different fluoroquinolone susceptibilities were studied and divided into ESBL-producing (n = 60) and non-ESBL producing (n=36) groups. MPC values were determined using an inoculum of 1010 cfu/ml on Mueller-Hinton plates with serial dilutions of the antibiotics. No significative differences were detected in MIC of ESBL-producing and non-ESBL producing strains of E. coli. Ciprofloxacin susceptible ESBL-producing strains exhibit higher MPC for ciprofloxacin and levofloxacin than non-ESBL producing strains. Our study helps to explain the frequent fluoroquinolone resistance found in ESBL-producing strains. In this context, doubts emerge about the advisability of using fluoroquinolones to treat infections caused by ESBL-producing strains.

 

Key words: Escherichia coli. Extended spectrum beta-lactamase. Fluoroquinolones.

Rev Esp Quimioter 2009;22(1):30-33 [pdf]

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Rev Esp Quimioter 2009;22(1):25-29

In vitro activity of fosfomycin against ESBL-producing enterobacteria of urinary origin

M.ª S. Hernández ,  J. Á. García y J. L. Muñoz 

  

In vitro activity of fosfomycin, compared with other antibiotics used for urinary tract infections (UTI), against extended spectrum beta-lactamase (ESBL)-producing Escherichia coli and Klebsiella pneumoniae clinical isolates obtained from UTIs, was determined. The activity of fosfomycin, co-trimoxazole, ciprofloxacin, nitrofurantoin, amoxicillin/ clavulanic acid and gentamicin against 71 ESBL-producing E. coli clinical isolates and 13 ESBL producing K. pneumoniae clinical isolates obtained from UTI was studied by the agar-dilution method or E-test. E. coli isolates produced mainly CTX-M type ESBL (76.1%), especially CTX-M 14 (56.3 %). K. pneumoniae isolates produced most predominantly SHV-type ESBL (92.3%), mainly SHV-2 (76.9 %). Gentamicin (4.4 %), fosfomycin (5.6 %) and nitrofurantoin (5.6 %) showed the lowest resistance proportions against E. coli. Co-trimoxazole and ciprofloxacin (7.7 %) showed the lowest resistance proportions against K. pneumoniae.

 

Key words: Escherichia coli. Klebsiella pneumoniae. Extended spectrum beta-lactamase (ESBL). Fosfomycin.

Rev Esp Quimioter 2009;22(1):25-29  [pdf]

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Rev Esp Quimioter 2009;22(1):20-24

Compliance rate of antibiotic therapy in patients with acute pharyngitis is very low, mainly when thrice-daily antibiotics are given

C. Llor ,  N. Sierra ,  S. Hernández ,  C. Bayona ,  M. Hernández ,  A. Moragas y O. Calviño 

  

Objective. To assess drug-compliance observed among patients with suspected streptococcal pharyngitis treated with twice-daily antibiotic regimens (b.i.d.) and others with thrice-daily regimens (t.i.d.).

Methods. A prospective study in the primary care setting was designed in which patients with pharyngitis and three or more Centor criteria, non-allergic to beta-lactam agents, treated with several b.i.d and t.i.d antibiotic regimens based on doctor’s choice, were recruited. Patient compliance was assessed with electronic monitoring.

Results. A total of 113 patients were enrolled (64 in the t.i.d. group and 49 in the b.i.d. group). Mean openings ranged from 70.3 to 83.3% of the total amount of pills. All the parameters analysed indicated significantly worse compliance with the t.i.d. regimens. Eleven patients allocated to the t.i.d. group took at least 80 % of the pills (17.2 %), this being significantly lower than those who received b.i.d. antibiotics (59.2%; p<0.001). The percentage of patients who opened the Medication Event Monitoring System (MEMS) container the satisfactory number of times a day was systematically lower among t.i.d. regimens, this being statistically significant from day three (p<0.05). Patients assigned to t.i.d. regimens more frequently forgot the afternoon dose.

Conclusion. Compliance rate was very low, mainly when patients are given t.i.d antibiotic regimens. This may lead to storage of antibiotics and subsequent selfmedication. New strategies addressed to improve drugcompliance with antibiotics among outpatients are therefore necessary.

  

Key words: Compliance. Pharyngitis. Streptococcal infection. Amoxicillin. Penicillin. Antibiotic.

Rev Esp Quimioter 2009;22(1):20-24  [pdf]  

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