Treatment of human infections caused by Bartonella spp.
L. PÉREZ-MARTÍNEZ, J. R. BLANCO, J. A. OTEO
Infections by Bartonella spp. include a wide spectrum of emerging and re-emerging infectious diseases.There is not a universal therapy for this infection, therefore treatment should be chosen individually. The aim of this review is to update the therapeutics aspects of this kind of infections.
Rev Esp Quimioter 2010:23(3):109-114 [pdf]
Endotoxin adsortion as adjuvant therapy in gramnegative severe sepsis
F.J. CANDEL, F. MARTÍNEZ-SAGASTI, M. BORGES, E. MASEDA, M. HERRERA-GUTIÉRREZ, J. GARNACHO-MONTERO, F.J. MAYNAR, R. ZARAGOZA, J. MENSA, J.R. AZANZA
The mortality rate of severe sepsis and septic shock remains still high. Within the last years a better knowledge of its physiopathology and the implementation of a group of measures addressed to a fast identification and early treatment of the septic patients have proved to reduce mortality rate. Likewise, it continues being investigated in modulating the inflammatory response and limiting the harmful action of the bacterial products on the immune system. As a result of this research some endotoxin adsorber devices have been designed to control one of the most important targets that start the inflammatory cascade when gramnegative microorganisms are involved.The usefulness that these endotoxin removal devices might have as adjuvant treatment in the Septic Syndrome and its applicability are reviewed in this paper. Likewise a profile of patient that might be to the benefit of this therapy is suggested according to the current knowledge.
Rev Esp Quimioter 2010:23(3):115-121 [pdf]
Nonantimicrobial effects of tetracyclines
L. GARCÍA-ÁLVAREZ, J. A. OTEO
Tetracyclines are a family of antibiotics very common in clinical practice that have been used in not infectious affections. One of their most studied actions is their ability to inhibit matrix metalloproteinases (MMPs), a group of proteinases that have been implicated in pathological processes as oncogenesis and inflammation. Tetracyclines have been shown to play an important role in malignant angiogenesis and cancer invasion, which is related with tumor aggressiveness and metastatic potential. They also show anti-inflammatory activity in neurological, respiratory, bone and heart diseases, and in rheumatologic and dermatologic processes. The aim of this review is to make an updating about the non antimicrobial actions of tetracyclines, specially their therapeutic applications in different diseases.
Rev Esp Quimioter 2010:23(1):4-11 [pdf]
Antifungal activity of posaconazole against Candida spp. and non-Candida clinical yeasts isolates
A. J. CARRILLO-MUÑOZ, C. TUR-TUR, J. M. HERNÁNDEZ-MOLINA, G. QUINDÓS, C. MARCOS-ARIAS, E. ERASO, D. CÁRDENES, O. ORTIZ-MAESTRO, P. SANTOS, D. ESTIVILL, C. GUARDIA, G. GIUSIANO
The in vitro antifungal activity of posaconazole was tested against 315 yeast clinical isolates and 11 ATCC reference strains by means an agar diffusion method (Neosensitabs, Rosco,Denmark) based in CLSI M44-A2 document. Posaconazole activity was excellent against Cryptococcus and Rhodotorula species studied and showed very good activity against most species of Candida tested. A total of 13 clinical isolates (4.1%) were resistant: Candida albicans (n=5), Candida glabrata (n=5), Candida tropicalis (n=1), Geotrichum australiensis (n=1) and Geotrichum capitatum (n=1). Our results suggest posaconazole is an effective antifungal agent against the most clinically important yeasts species (92.7% of susceptibility). Agar diffusion method provides good conditions for the posaconazole susceptibility study in the routine laboratory.
Rev Esp Quimioter 2010:23(3):122-125 [pdf]
Multidrug resistant Acinetobacter baumanii: clinical update and new highlights
A. HERNÁNDEZ, E. GARCÍA, G. YAGÜE, J. GÓMEZ
The role of multidrug resistant Acinetobacter baumanii and its clinical relevance have been recently appreciated as a ubiquitous opportunistic nosocomial pathogen. Risk factors associated with A. baumanii infection include severe underlying diseases, previous surgery, invasive procedures, treatment with broad-spectrum antibiotics, length of hospital stay, admission to intensive care units (ICU). Carbapenem-multidrug resistant A. baumanii infections are probably associated to greater severity and more complications; in our cohort mortality was 49.3% and related mortality (within 72 hours) was 10.39%. However, severe underlying diseases probably play an important role in the clinical outcome of patients with MDR-C A. baumanii infection and controversy exists regarding the real mortality attributable to antimicrobial resistance because a high proportion of deaths took place > 7 days after diagnosis. Nevertheless, in our experience, carbapenem resistance, inappropriate therapy and monotherapy are associated to a higher mortality. Special attention should be paid to design well-controlled prospective clinical trials to determine the optimal antimicrobial therapy in critically ill patients suspected of having MDR Acinetobacter infection.
Rev Esp Quimioter 2010:23(1):12-19 [pdf]
Critical study of spanish adult consumer profile of antibiotics on the basis of National Surveys of Health in 1993, 1995, 1997, 2001 and 2003
J. L. BAQUERO, J. BARBERÁN, D.MARTÍNEZ
Objective: The objective of this study has been to examine antibiotic consumption in Spain through the use of the National Surveys of Health (NSH) .
Material and methods: Taking the NSH, between 1993 and 2003, certain variables regarding the consumption of antibiotics have been analyzed; putting these into groups according to their typology, habits, comorbidity and the utilization of health resources. This information has been compared with published data by other authors.
Results: The consumption of antibiotics was approximately 3%, and 9-19% of this was not prescribed. Significant statistical associations have been observed between the consumption of antibiotics and other aspects such as academic and income levels, habits such as smoking, general health, certain chronic diseases, being bed-ridden due to disease; and also the use of certain medicines and the anti-influenza vaccine.
Conclusions: Consumption of antibiotics coincides with described data by other authors, and this was always higher than prescribed. The association with other variables may be limited by the inadequate NSH design in order to know the exact consumption of antibiotics.
Rev Esp Quimioter 2010:23(3):126-134 [pdf]
Pseudomonas aeruginosa: antimicrobial resistance in clinical isolates. Castellón 2004 -2008
F. J. PARDO, M. D. TIRADO, E. D. GARCÍA, J. GRANADOS, A. CAMPOS, R. MORENO
Retrospective study of antimicrobial susceptibility of 1.943 Pseudomonas aeruginosa clinical isolates to amikacin, tobramycin, gentamicin, ceftazidime, cefepime, meropenem, piperacillin-tazobactam and ciprofloxacin during a five year period. The percentage of resistance went from 2.07% to amikacin from 15.89% to ciprofloxacin. These percentages showed differences depending on the extra or intrahospitalary origin, departments and samples. Isolates from hospital patients were significantly more resistant than the ones from ambulatory patients (p≤0.001:tobramycin, 13.74% vs 5.05%; gentamicin, 13.74% vs 8.26%; ceftazidime, 12.67% vs 4.24%; cefepime, 11.48% vs 7.07%; meropenem, 8.57% vs 2.06%),except for amikacin (1.98% vs 2.2%, p=0.74), piperacillin/tazobactam (6.07% vs 4.55%, p=0.14) and ciprofloxacin (17.17% vs 13.97%, p=0.06). Critical care department and respiratory samples showed the highest resistance percentages while surgery department and invasive samples showed the lowest. Multidrug-resistance was found in 4.8% of the isolates. When comparing our data with those from our previous study (1992-2003), we observed a significant reduction in antibiotic resistance to amikacin (7.74% vs 2.07%, p<0.001), tobramycin (13.61% vs 10.26%, p<0.001), gentamicin (30,85% vs 14.73%, p<0,001), ceftazidime (14.63% vs 9,28%, p<0.001), cefepime (12,31% vs 9.71%, p=0.005), and meropenem (7.74% vs 2.07%, p=0.001); and there were no changes in resistance to piperacillin- tazobactam (4.26% vs 5.46%, p=0,06) and ciprofloxacin (16.02% vs 15.89%, p=0.89). In the last years, the susceptibility pattern of P. aeruginosa to antimicrobial agents has changed in our health district, and it is very different from the one described in national studies so it would be very important to monitore susceptibility of clinical isolates periodically.
Rev Esp Quimioter 2010:23(1):20-26 [pdf]
Impact factor and quality of scientific publications on Microbiology: the example of the Spanish Journal of Chemotherapy
D. CARABANTES
Introduction. The impact factor of a journal is the quantitative analysis of the number of citations obtained during a specific period of time. This currently is the standard tool to measure the quality of the publication and a way to evaluate the research trajectory of a scientist.
Methods. Search for bibliometric indicators: Journal Citation Reports, SCImago Journal Rank and Potencial Impact Factor for the Spanish Medical Journals of the Instituto de Historia de la Ciencia y Documentación López Piñero (IHCD). To identify criteria of editorial quality, of visibility and of spreading by reviewing databases such as the Online Regional Information System for Scholarly Journals from Latin America, the Caribbean, Spain and Portugal (LATINDEX), SciELO (Scientific Electronic Library Online), DIALNET and the Collective Periodical Publications Catalogue of Spanish Healthcare Science Libraries, known as C17.
Results. For the first time, the Spanish Journal of Chemotherapy appears in the 2009 edition of JCR, previously by joined the two spanish journals Clinical Microbiology and Infectious Diseases and International Microbiology, both ranked at a lower position. While calculating factors of national and international impact of the five publications included in the category of Pharmacology and Pharmacy as part of theproject initiated by the IHCD, the Spanish Journal of Chemotherapy showed the best results.
Conclusions.The Spanish Journal of Chemotherapy obtained good results in analysed bibliometric indicators, positioning it at the top of the ranking of Spanish medical journals. A good spreading helped to maintain visibility on the publication in the editorial field.
Rev Esp Quimioter 2010:23(3):135-143 [pdf]
Linezolid more efficacious than vancomycin to eradicate infecting organism in critically ill patients with Gram-positive infections
J. M. SIRVENT, L. PIÑEIRO, M. DE LA TORRE, M. MOTJÉ, J. DE BATLLE, A. BONET
Objetive: A prospective and observational study has been conducted to analyze the efficacious of linezolid compared to vancomycin to eradicate the infecting organism in critically ill patients with Gram-positive infections.
Patients and Methods: Prospective, observational and non-controlled study in a medical-surgical intensive care unit (ICU) in a university hospital. A total number of 53 critically ill patients with therapy to proven Grampositive bacterial infection were studied. Infected patients were diagnosed and treated according to international guidelines, following standard protocol for the critically ill infected patients. Microbiologic eradication of the infecting organism at the seventh day of treatment and patients’ clinical outcome were analysed.
Results: Twenty-seventh patients received linezolid and twenty-six received vancomycin. Infection-site diagnoses were: hospital-acquired pneumonia (21 cases: 39.6%), complicated surgical-site infection (19 cases: 35.8%) and catheter-related bacteraemia (13 cases: 24.5%).The most important isolated microorganism was methicillin-resistant Staphylococcus aureus (MRSA) (28 cases:52.8%). Clinical success was 20/27 (74.1%) in the linezolid group and 16/26 (61.5 %) in the vancomycin group, with p= 0.3. The adjusted logistic regression model demonstrated that the treatment with linezolid is associated to microbiologic eradication of the infecting organism at the seventh day of treatment [OR = 7.88 (95% CI 1.86-33.52)] and p = 0.005. In this model, the length of hospital stay was lower in the group with microbiologic eradication at the seventh day (p = 0.015). Drug-related adverse events were comparable in both groups of treatment.
Conclusion: Treatment with linezolid in critically ill patients with Gram-positive infections was equivalent to vancomycin in terms of efficacy and safety, but linezolid was associated to a higher rate of microbiologic eradication of the infecting organism at the seventh day of treatment.
Rev Esp Quimioter 2010:23(1):27-35 [pdf]
Comparative activity of doripenem, meropenem, and imipenem in recent clinical isolates obtained during the COMPACT-Spain epidemiological surveillance study
C. GIMENO, R. CANTÓN, A. GARCÍA, M. GOBERNADO Y GRUPO ESPAÑOL DE ESTUDIO DE DORIPENEM
Introduction. Doripenem is a new carbapenem with broad spectrum antibacterial activity indicated for the treatment of nosocomial pneumonia and complicated urinary and intraabdominal infections.
Methods. Isolates of Pseudomonas aeruginosa, Acinetobacter and Enterobacteriaceae from patients with nosocomial pneumonia, bacteremia and complicated intraabdominal infections attended in 16 Spanish hospitals were included (October 2008–May 2009). Susceptibility to imipenem, meropenem and doripenem was studied with the Etest method, and the results were interpreted according to the EUCAST criteria.
Results. Considering all the isolates, doripenem (MIC50 0.12 mg/L) was 2- to 8-fold more active than meropenem (0.25 mg/L) and imipenem (1 mg/L). In relation to Enterobacteriaceae, the MIC50 and MIC90 values of doripenem and meropenem were similar (0.03 and 0.12 mg/L, respectively) and clearly superior to those of imipenem (0.25 and 1 mg/L). In the case of P. aeruginosa, MIC50 and MIC90 were more favorable to doripenem (0.25 and 16 mg/L) than to meropenem (0.5 and ≥64 mg/L) or imipenem (2 and ≥64 mg/L). In this species, the percentage of strains with lower MIC values for doripenem among those exhibiting intermediate susceptibility and resistance to meropenem was 63.0% (29/46) and 61.7% (63/102), respectively, versus only 4.3% (2/46) and 1.9% (2/102) with higher MIC values for doripenem.
Conclusions.The results obtained in this study are similar to those reported in other countries, and reinforce the superior in vitro activity of doripenem versus the other carbapenems and its position in the treatment guidelines regarding the nosocomial infections for which it is indicated.
Rev Esp Quimioter 2010:23(3):144-152 [pdf]
