Rev Esp Quimioter 2013:26(1):12-20

Physicians with access to point-of-care tests significantly reduce the antibiotic prescription for common cold                                 
 

C. LLOR, S. HERNÁNDEZ, J. M. COTS, L. BJERRUM, B. GONZÁLEZ, G. GARCÍA, J. D. ALCÁNTARA, G.  GUERRA, M. CID, M. GÓMEZ, J. ORTEGA, C. PÉREZ, J. ARRANZ, M. J. MONEDERO, J. PAREDES, V. PINEDA, GRUPO DE TRABAJO HAPPY AUDIT ESPAÑA               

Objective. This study was aimed at evaluating the effect of two levels of intervention on the antibiotic prescribing in patients with common cold.
Methods. Before and after audit-based study carried out in primary healthcare centres in Spain. General practitioners registered all the episodes of common cold during 15 working days in January and February in 2008 (preintervention). Two types of intervention were considered: full intervention, consisting in individual feedback based on results from the first registry, courses in rational antibiotic prescribing, guidelines, patient information leaflets, workshops on rapid tests –rapid antigen detection and C-reactive protein tests– and provision of these tests in the surgeries; and partial intervention, consisting of all the above intervention except for the workshop and they did not have access to rapid tests. The same registry was repeated in 2009 (postintervention). In addition, new physicians filled out only the registry in 2009 (control group).
Results. 210 physicians underwent the full intervention, 71 the partial intervention and 59 were assigned to the control group. The 340 doctors prescribed antibiotics in 274 episodes of a total of 12,373 cases registered (2.2%).The greatest percentage of antibiotic prescription was found in the control group (4.6%). The partial intervention increased the antibiotic prescription percentage from 1.1% to 2.7% while only doctors who underwent the complete intervention lead to a significant reduction of antibiotics prescribed, from 2.9% before to 0.7% after the intervention (p<0.001).
Conclusion. Only physicians with access to rapid tests significantly reduced antibiotic prescription in patients with common cold.

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Rev Esp Quimioter 2013:26(2):116-118

Accuracy of Etest method to study Campylobacter spp. susceptibility to erythromycin, ciprofloxacin and tetracycline                                
 

NURIA SANZ-RODRÍGUEZ, MARÍA TERESA PÉREZ-POMATA, OLHA STELMAKH, DAVID PÉREZ-BOTO, JOSÉ LUIS GÓMEZ-GARCÉS             

Introduction. In industrialized countries Campylobacter jejuni is the enteropathogen most frequently isolated from the feces of patients with gastroenteritis. The Etest accuracy to categorize Campylobacter spp. susceptibility to erythromycin, ciprofloxacin and tetracycline was evaluated.
Methods. Ninety strains were studied. The Etest® was performed following the manufacturer’s instructions on commercial plates of Mueller-Hinton blood. The breakpoints were those recommended by the Clinical Laboratory Standards Institute (CLSI) for broth microdilution. The gold standard was the broth microdilution method as recommended by CLSI.
Results. The Etest agreement with the reference method was 100%, 97% and 98% for erythromycin, ciprofloxacin and tetracycline, respectively. No major or very major errors were found.
Conclusions. The Etest results are equivalent to those obtained using the gold standard. The Etest is a valid method to determine susceptibility to tetracycline. It is also a suitable method to categorize strains classified as non-resistant to erythromycin and ciprofloxacin by the diffusion method.

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Rev Esp Quimioter 2013:26(4):337-345

Staphylococcus aureus infections and factors associated with resistance to methicillin in a hospital emergency department 

JUAN GONZÁLEZ-CASTILLO, CATERINA CENCI, ESTHER RODRIGUEZ-ADRADA, FRANCISCO JAVIER CANDEL, FERNANDO DE LA TORRE-MISIEGO, CRISTINA FERNÁNDEZ, FRANCISCO JAVIER MARTÍN-SÁNCHEZ             

Objective. Assessment of the characteristics of patients with Staphylococcus aureus (SA) infections, and factors associated with resistance to methicillin in a hospital emergency department (ED) in Spain.
Materials and Methods. All adult patients admitted between January 2007 and December 2010 with a SA infection confirmed by a positive culture in a sample obtained in the hospital emergency department were selected for enrolment. Epidemiological, clinical, therapeutic and microbiological variables were retrospectively collected from the patients’ medical charts. The variable assessed within the primary outcome of the study was the isolation of methicillin resistant Staphylococcus aureus (MRSA). For the purpose of the analysis, the sample was divided in terms of the presence or not of the resistance to methicillin and a logistic regression analysis was performed to identify the factors associated with isolation and empirical antibiotic coverage of MRSA.
Results. A total of 207 patients with a confirmed SA infection were included in the study analysis, with a mean age of 64.7 (SD 20) years. MRSA was isolated in a total of 63 (30.4%) patients, and a linear incremental trend was observed over the course of the study (p=0,047). MRSA was empirically covered in the emergency department on an average rate of one in three patients. Independent factors associated with the isolation of MRSA were: age above 65 years [OR 2.97 (95% CI 1.24 to 7.1), P = 0.014], severe baseline functional dependence [OR 2.41 (95 % 1.02 to 5.69), P = 0.045], chronic obstructive pulmonary disease [OR 4.83 (95% CI 1.88 to 12.42), P = 0.001], history of antibiotic treatment within the previous 2 months [OR 4.94 (95% CI 2.27 to 10.76), P <0.001] and a confirmed urinary infection [OR 5.98 (95% CI 1.65 to 21.69) p = 0.007]. Independent factors associated with empiric coverage of MRSA in the ED were history of antibiotic treatment within the previous 2 months [OR 3.88 (95% CI 1.76 to 8.57), P <0.001] and the presence of a catheter device [OR 6.28 (95% CI 1.64 to 24.07), P = 0.007].
Conclusions. Resistance to methicillin appears to be increasingly frequent in patients infected with SA admitted in our emergency department and there appears to be a need for a more optimal empiric antibiotic treatment in these patients.

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Rev Esp Quimioter 2013:26(1):21-29

Morbidity and mortality associated with primary and catheter-related bloodstream infections in critically ill patients                                  
 

P. M. OLAECHEA, M. PALOMAR,  F. ÁLVAREZ-LERMA,  J. J. OTAL,  J. INSAUSTI,  M. J. LÓPEZ-PUEYO Y EL GRUPO ENVIN-HELICS                

Purpose. To analyze the impact of primary and catheter related bloodstream infections (PBSI/CRBSI) on morbidity and mortality.
Methods. A matched case-control study (1:4) was carried out on a Spanish epidemiological database of critically ill patients (ENVIN-HELICS). To determine the risk of death in patients with PBSI/CRBSI a matched Cox proportional hazard regression analysis was performed.
Results. Out of the 74,585 registered patients, those with at least one episode of monomicrobial PBSI/CRBSI were selected and paired with patients without PBSI/CRBSI for demographic and diagnostic criteria and seriousness of their condition on admission to the Intensive Care Unit (ICU). For mortality analysis, 1,879 patients with PBSI/CRBSI were paired with 7,516 controls. The crude death rate in the ICU was 28.1% among the cases and 18.7% among the controls. Attributable mortality 9.4% (HR:1.20; 95% confidence interval: 1.07–1.34; p<0.001). Risk of death varied according to the source of infection, aetiology, moment of onset of bloodstream infection and severity on admission to the ICU. The median stay in the ICU of patients who survived PBSI/CRBSI was 13 days longer than the controls, also varying according to aetiology, moment of onset of bloodstream infection and severity on admission.
Conclusions. Acquisition of PBSI/CRBSI in critically ill patients significantly increases mortality and length of ICU stay, which justifies prevention efforts.de prevención.

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Rev Esp Quimioter 2013:26(2):119-127

Bacteraemia at a second level hospital: epidemiological study, analysis of pronostic factors associated to mortality and economic cost estimation                                
 

JOSÉ JOAQUÍN HERNÁNDEZ-ROCA, ELISA GARCÍA-VÁZQUEZ, ALICIA HERNÁNDEZ, MANUEL CANTERAS, JOSÉ ANTONIO HERRERO, EVA CASCALES, ENRIQUE MENÉ-FENOR, JOAQUÍN GÓMEZ-GÓMEZ
             

Introduction. Bacteraemia (B) accounts for a considerable proportion (0.36%) of all hospital admissions due to infections diseases and it is associated to increased hospital costs. The aim of this study is to describe a cohort of patients with bacteraemia  at a second level hospital, to analyze factors associated to mortality and its economical impact during hospital admission.
Patients and Methods. Observational study of a cohort of adult patients with bacteraemia admitted at a second level hospital during 2010. Data collection from clinical records has been done according to a standard protocol: epidemiological and clinical variables and factors associated to mortality were analysed. Total economical cost per patient was estimated.
Results. 148 patients were included: 80 community B (55.4%), 23 health care associated B (15.5%) and 45 nosocomial B (28.5%). The incidence was 9 cases 10.000 persons/year. Mean age was 69 years and the global mortality was 24%. In bivariate analysis smoking, diabetes mellitus, McCabe Jackson score type I-II, Pitt Index ≥ 3, APACHE ≥ 20, Glasgow ≤9, shock, respiratory distress, invasive procedures, nosocomial bacteraemia and inadequate empiric or definitive antibiotic treatment were associated to mortality (p<0.05). Factors associated to mortality in multivariate analysis included McCabe Jackson score type I-II (OR 4.95; 95% CI 1.095-22.38), haemodialysis during acute stage (OR 7.8; 95% CI 2.214-27.773) and inadequate empiric antibiotic treatment (OR 7.68; 95% CI 19.82-29.77). Admission economic cost per patient was 9,459€ for community acquired bacteriemia, 5,656€ for health care associated bacteraemia and 41,680€ for nosocomial bacteraemia.
Conclusions. Comorbidity, inadequate empiric antibiotic treatment and haemodialysis during acute phase are statistically significantly in our cohort of patients with bacteraemia.

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Rev Esp Quimioter 2013:26(4):346-352

Influence of ethnicity on the pharmacokinetics of amikacin 

MELISA BARRANTES-GONZÁLEZ, SANTIAGO GRAU, DAVID CONDE-ESTÉVEZ, ESTHER SALAS, MÓNICA MARÍN-CASINO             

Objective. Despite the increasing ethnic diversity, there are few studies of its influence on the pharmacokinetics of amikacin. The objective of this study was to compare the pharmacokinetics of amikacin in different populations: Asian, Hispanic, North Africans and Caucasian.
Methods. A retrospective observational study was performed in a tertiary teaching hospital during eight years. It was included all patients with intravenous amikacin treatment in extended interval dosing regimen with therapeutic drug monitoring of amikacin. Pharmacokinetic parameters were analysed. A bivariate and multiple linear regression statistical analysis were carried out.
Results. 164 patients were included: 7 asians, 135 Caucasians, 11 Hispanics and 11 from North Africa. It was shown a lower plasma concentrations of amikacin in North Africa population due to its greater clearance.
Conclusions. Amikacin plasma concentrations monitoring is advisable in patients from North Africa in order to avoid subtherapeutic concentrations.

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Rev Esp Quimioter 2013:26(1):30-33

Pyelonephritis in pregnancy. How adequate is empirical treatment?                                  
 

A. ARTERO, J. ALBEROLA, J.M. EIROS,  J.M. NOGUEIRA, A. CANO                 

Objective. To ascertain the adequacy of empirical antimicrobial treatment in pregnant women with acute pyelonephritis.
Material and methods. We have conducted a retrospective observational study of women admitted to the hospital with acute pyelonephritis between May 2004 and April 2011.
Patients were included if the results of urine cultures and susceptibility testing to antibiotics were available. Epidemiological, clinical, therapeutical and outcome variables were collected from chart review. We considered inappropriate empirical antimicrobial treatment (IEAT) as the occurrence of microorganism that were not effectively treated at the time when the causative microorganism and its antibiotic susceptibility were known.
Results. Fifty women with appropriate microbiological data from a total of 93 cases of acute pyelonephritis were included in the study. The women’s mean age was 26.4 years, and 58% were nulliparous. Pyelonephritis was developed in the 2nd and 3rd trimester in 88% of cases. Previous urinary tract infections were recorded in 34%. Escherichia coli was the most frequent microorganism (70%). The proportion of patients who received IEAT was 10%. Amoxicillin-clavulanate and cepahlosporines were the most predominant antibiotics used, with a proportion of IEAT of 10.3% and 5.9%, respectively.
Conclusions. Pregnant women with pyelonephritis received IEAT in a small but significant number of cases. Amoxicillin-clavulante and cephalosporines were adequate in most cases. More studies are needed to define the clinical impact of IEAT on prognosis.

 

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Rev Esp Quimioter 2013:26(2):128-130

A rare case of Meleney’s Ulcer after partial chemical matricectomy                                
 

MARTA ELENA LOSA-IGLESIAS, RICARDO BECERRO-DE-BENGOA-VALLEJO
             

Background. Meleney’s ulcer is a rare, but potentially deadly infection that often occurs in post-surgical sites. This type of ulcer has not previously been reported in the toenail after phenol matricectomy.
Patient Case. A female patient underwent partial phenolization of the medial nail matrix of the hallux, but after 2 months had a recurrent spicula that caused Meleney’s ulcers.
Results. The ulcers remained after treatment with antibiotics, and further surgery was required to fully clear the infection.
Conclusion. This case and review of Meleney’s ulcer highlights the deceptively benign initial presentation of necrotizing fasciitis at the hallux after partial chemical matricectomy surgery using a phenol-based approach.

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Rev Esp Quimioter 2013:26(4):353-359

Prosthetic joint infections due to methicillin-resistant and methicillin-susceptible staphylococci treated with open debridement and retention of the prosthesis 

EDUARD TORNERO, LAURA MORATA, JUAN C MARTÍNEZ-PASTOR,  GUILLEM BORI, JOSEP MENSA, ALEX SORIANO             

Objectives. To compare the specific characteristics, the outcome and the predictors of failure of prosthetic joint infections (PJI) due to methicillin-resistant (MRS) and methicillin-susceptible staphylococci (MSS) treated with open debridement and retention of the implant.
Material and methods. PJI due to MRS or MRS prospectively registered in a database from 1999 to 2009 were retrospectively reviewed.
Results. During the study period, 96 patients met the inclusion criteria of the study. The mean follow-up period was 3.9 years and at least 2 years in all patients. The failure rate was 25%. The only variable significantly associated with failure in the global cohort was polymicrobial infection (59.3% vs. 40.7%, p=0.036). Thirty-four (35.4%) patients had an infection due to MRS and 62 (63.6%) due to MSS. Among MSS infections, 95.2% corresponded to primary arthroplasties while 29.4% of PJI due to MRS were after revision arthroplasties (p=0.001). CRP was significantly higher in PJI due to MSS (5.2 mg/dl vs 9.1 mg/dL, p=0.02).The failure rate (20% vs 27%, p=0.62) was very similar in MSS and MRS groups.
Conclusion. PJI due to MRS were mainly coagulase-negative staphylococci, more frequent after revision arthroplasties, had a lower inflammatory response, and had a similar failure rate than MSS infections.

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Rev Esp Quimioter 2013:26(1):34-38

Invasion of solid culture media: a widespread phenotypic feature of clinical bacterial isolates                                  
 

F. GÓMEZ-AGUADO, M. T. CORCUERA, C. GARCÍA-REY,  M. L. GÓMEZ-LUS, C. RAMOS, M. J. ALONSO, J. PRIETO                  

Objectives. The in-depth growth in solid culture media is a common feature in filamentous fungi and yeasts. However, there are very few bacterial species in which this phenomenon has been documented. The aim of this work was to assess the agar invasiveness of a wide range of Gram-positive and Gram-negative bacterial species of clinical interest.
Material and methods. Three different clinical isolates for each of eleven bacterial species were plated onto Columbia blood agar and let grow up to 15 days. Isolated colonies were processed by histological methods, embedded in epoxy resin, and then, semithin sections were stained with toluidine blue and visualized by light microscopy.
Results. Growth within the agar was observed in at least one strain in 9 of the 11 studied species. Invasions of Gramnegative rods were small, not plentiful, and round or triangleshaped. In Gram-positive cocci, invasions were of big size, abundant and of variable shape (lentiform, globular, irregular, arrowhead) depending on the species.
Conclusions: We propose that the growth within the agar can indicate a survival strategy common to many bacterial species, and so far, not previously reported. This strategy could be either a nutrient gradient tropism or the spread and colonization of new ecological niches, with potential implications in pathogeny.

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