Rev Esp Quimioter 2013:26(4):287-297

Immunization practices for workers. Update recommendations

MARÍA CARMEN SÁENZ-GONZÁLEZ, IGNACIO HERNÁNDEZ-GARCÍA             

Introduction. Infectious diseases are a major cause of morbidity and mortality in the workplace. Worker vaccination against a number of infectious diseases is considered the most effective strategy of primary prevention to control them.
Sources. A literature review was performed in Medline and websites of Spanish scientific societies were consulted to detect workers vaccination recommendations. The inclusion criteria was that the recommendation had been made from January 2007 to October 2012.
Development. Seventeen papers were selected and websites of the Ministry of Health, Spanish Society of Chemotherapy, Spanish Society of Preventive Medicine, Public Health and Hygiene, and Vaccinology Spanish Association provided relevant information to our review. Groups of workers at increased risk of acquiring infectious diseases during their professional activity were determined, and vaccination recommendations were established (vaccination against tetanus, diphtheria, pertussis, hepatitis A, hepatitis B, pneumococcus, meningococcus, measles, rubella, mumps, chickenpox, influenza, Haemophilus influenzae b, typhoid, polio, tuberculosis and rabies).
Conclusions. Epidemiological changes in recent years, with the re-emergence of some diseases such as whooping cough, measles or mumps, force the exposed workers (especially the health care workers) to check their immune status.

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Rev Esp Quimioter 2013:26(2):103-107

Reasons for the introduction of darunavir in the antirretroviral treatment in HIV-infected patients                                
 

ENRIC PEDROL, JUAN CARLOS LÓPEZ-BERNALDO DE QUIRÓS, SHEILA RUIZ, HENAR HEVIA, FRANCISCO LEDESMA             

Introduction. In 2009 a deep change in ARV treatment took place in Spain with the introduction of new ARV drugs.The principal objective of the study was to determine the clinical situation of the patients in which DRV/r was introduced in the ARV therapy.
Methods. Observational, cross sectional and multicentre study in which 91 reference hospitals participated. Patient’s enrolment was carried out between 2008 and 2009. Data were collected retrospectively considering standard clinical practice.
Results. 719 medical records were reviewed. Patients had a different clinical situation compared to nowadays with predominance of multiresistant virus which leaded to virologic failure. The principal reason for introducing DRV/r in the ARV regimen was the virologic failure (54.2%).
Conclusions. Considering this situation, DRV/r became a therapeutic option which represented a change in the ARV paradigm in that period.

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Rev Esp Quimioter 2013:26(4):298-311

Prevention and control of nosocomial and health-care facilities associated infections caused by species of Candida and other yeasts

JAVIER PEMÁN, RAFAEL ZARAGOZA, MIGUEL SALAVERT             

Knowledge of the epidemiology of invasive fungal diseases caused by yeasts (Candida spp., especially) in health care settings allows the establishment of the levels necessary for its prevention. A first step is to identify groups of patients at high risk of nosocomial invasive fungal infections, establish accurate risk factors, observing the periods of greatest risk, and analyze the epidemiological profile in genera and species as well as the patterns of antifungal resistance. Secondly, mechanisms to avoid persistent exposure to potential fungal pathogens must be programed, protecting areas and recommending measures such as the control of the quality of the air and water, inside and outside the hospital, and other products or substances able to cause outbreaks. Finally, apart from the correct implementation of these measures, in selected patients at very high risk, the use of antifungal prophylaxis should be considered following the guidelines published.

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Rev Esp Quimioter 2013:26(1):1-5

Use of peripheral catheters: too much to learn                                 
 

J. A. CAPDEVILA               

Frequently incident complications due to the use of peripheral catheters are considered not relevant. However, recently multiple observational studies have demonstrated its role causing nosocomial bacteraemia. Guidelines about prevention of catheter-related infection are focused in central lines instead of peripheral ones. This approach causes an important lack of knowledge about the best manner to manipulate peripheral lines.
Risk factors related to the development of a peripheral phlebitis, its clinical relevance and doubts related to prevention are presented and discussed in this article. The main objective is to alert about the importance of peripheral catheters in the prevention of nosocomial infection.

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Rev Esp Quimioter 2013:26(2):108-111

Serological markers of Spanish and immigrant pregnant women in the south of Madrid during the period 2007-2010                                
 

FÁTIMA LÓPEZ-FABAL, JOSÉ LUÍS GÓMEZ-GARCÉS             

Objective. The prevalence and evolution of the markers including in the serologic profile of pregnant woman was studied in our hospital during a period of 4 years.
Material and methods. A retrospective study of the prevalence of antibodies against Treponema pallidum, human immunodeficiency virus (HIV), Toxoplasma gondii, rubeola virus and hepatitis B virus (HBV), was performed in our hospital among Spanish and immigrant pregnant women, from January 2007 to December 2010.
Results. A total of 8,012 pregnant were studied, 2,752 (34.2%) of them were foreign. The non-treponemal tests (RPR) were positive in 40 (0.49%) women, being the prevalence slightly superior in foreigners than in natives (0.8 as opposed to 0.3%). The IgG anti-T. gondii global prevalence was 23,35% (1,874 patients). In Spanish pregnant this prevalence was 18%, and 33.8% in the immigrant women. Almost the total of Spanish pregnant (99.5%) displayed IgG antibodies against rubeola virus whereas in the foreigners this rate was 61.6%. The presence of HBsAg for HBV was tested in 86.6% of pregnant women (6,939/8,012), being positive the 0.75% (59 patients), with a prevalence in foreigners greater than in Spanish (1.65 as opposed to 0.4%). Antibodies anti-HVI were detected in 22 patients (0.22%), being the prevalence 0.15% among the Spanish and 0.51% among the foreigners.

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Rev Esp Quimioter 2013:26(4):312-331

Bugs, hosts and ICU environment: Countering pan-resistance in nosocomial microbiota and treating bacterial infections in the critical care setting 

EMILIO MASEDA, JOSÉ MENSA, JUAN-CARLOS VALÍA, JOSE-IGNACIO GOMEZ-HERRERAS, FERNANDO RAMASCO, ENRIC SAMSO, MIGUEL-ANGEL CHIVELI, JORGE PEREIRA, RAFAEL GONZÁLEZ, GERARDO AGUILAR, GONZALO TAMAYO, NAZARIO OJEDA, JESÚS RICO, MARÍA JOSÉ GIMENEZ, LORENZO AGUILAR             

ICUs are areas where resistance problems are the largest, and they constitutes a major problem for the intensivist’s clinical practice. Main resistance phenotypes among nosocomial microbiota are: i) vancomycin-resistance/heteroresistance and tolerance in grampositives (MRSA, enterococci) and ii) efflux pumps/enzymatic resistance mechanisms (ESBLs, AmpC, metallobetalactamases) in gramnegatives. These phenotypes are found at different rates in pathogens causing respiratory (nosocomial pneumonia/ventilator-associated pneumonia), bloodstream (primary bacteremia/catheter-associated bacteremia), urinary, intraabdominal and surgical wound infections and endocarditis in the ICU. New antibiotics are available to overcome non-susceptibility in grampositives; however, accumulation of resistance traits in gramnegatives has lead to multidrug resistance, a worrisome problem nowadays. This article reviews by microorganism/infection risk factors for multidrug resistance, suggesting adequate empirical treatments. Drugs, patient and environmental factors all play a role in the decision to prescribe/recommend antibiotic regimens in the specific ICU patient, implying that intensivists should be familiar with available drugs, environmental epidemiology and patient factors.

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Rev Esp Quimioter 2013:26(1):6-11

Malaria diagnosis and treatment: analyse of a cohort of hospitalised patients at a tertiary level hospital (1998-2010)                                 
 

M. A. IBORRA, E. GARCÍA, B. CARRILERO, M. SEGOVIA               

Introduction. The increasing frequency of malaria infection in our area is due to the rise in international travel and immigration from endemic malaria areas. The aim of this study is to describe the chemoprophylaxis taken and treatment given as well as the clinical, epidemiological and microbiological characteristics for those patients admitted to our hospital with malaria.
Methods. A retrospective study of patients with malaria admitted to the Hospital Virgen de la Arrixaca, between January 1998 and December 2010, was carried out.
Results. During this period, fifty one cases of malaria were diagnosed. 78.3% of them were immigrants of whom 65% resided in Spain and had travelled to their country of origin for a short stay. Seventy four per cent acquired the infection in central and west Africa, and Plasmodium falciparum was responsible for the majority of the cases (88%). Only four patients had taken antimalarial chemoprophylaxis but none correctly.
The most frequently treatment used was a combination of quinine and doxycicline (64.7%). Inappropriate anti-malarial treatment occurred in 9 patients (17.6%). At least one indicator of severe malaria was established in 23.5% of the cases; however, the clinical outcome was successful in every case and no patient died.
Conclusions. Imported malaria is observed mostly among immigrants who travel to their countries of origin for a short stay and do not take anti-malarial prophylaxis, increasing the risk of acquiring malaria. Inappropriate malarial treatment is relatively frequent in the case management of imported malaria.

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Rev Esp Quimioter 2013:26(2):112-115

Emergence of high-level resistance to gentamicin and streptomycin in Streptococcus agalactiae in Buenos Aires, Argentina                                
 

HUGO EDGARDO VILLAR, MÓNICA BEATRIZ JUGO             

Introduction. Streptococcus agalactiae has become recognized as a cause of serious illness in newborns, pregnant women, and adults with chronic medical conditions. Optimal antimicrobial therapy for serious infections requires the use of synergistic combinations of a cell wall-active agent, such as a penicillin, with an aminoglycoside, which results in bactericidal activity against this organism. The synergistic effect is eliminated by the acquisition of high-level resistance (HLR) to aminoglycosides. The aim of our study was to determine the prevalence of HLR to gentamicin (GEN) and streptomycin (EST). The ability to detect HLR using a standard agar screen plate and high-content discs was investigated.
Methods. This study was conducted with 141 strains of S. agalactiae isolated from vaginal and rectal swabs of pregnant women at term. Minimum inhibitory concentrations (MICs) to GEN and STR were determined by the E-test method. Disks of GEN (120 μg) and STR (300 μg) were used to detect HLR. Agar screening plates were performed with GEN 100 mg/L, GEN 500 mg/L and STR 2000 mg/L.
Results. The HLR to GEN and STR was detected in 13.5% and 16.3% of the isolates respectively. Among 141 strains, 7.8% were simultaneously resistant to GEN and STR. With 120-μg GEN and 300-μg STR disks, strains for which MICs were ≥512 mg/L and ≥1024 mg/L had no zones of inhibition. Isolates with inhibitory zones for GEN and STR of ≥13 mm showed a MICs ≤64 mg/L and ≤512 mg/L. All the screening plates were negative for these isolates. HLR to aminoglycosides was associated (83.9%) with resistance to erythromycin and/or clindamycin.
Conclusions. This study highlights the emergence of strains with HLR to aminoglycosides. The disk-agar diffusion test performed with high-content aminoglycoside disks and screening plates can provide laboratories with a convenient and reliable method for detecting S. agalactiae isolates that are resistant to aminoglycoside-betalactam synergy.

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Rev Esp Quimioter 2013:26(4):332-336

Antimicrobial resistance in tuberculosis 

JUAN BAUTISTA GUTIÉRREZ-AROCA, PILAR RUIZ, MANUEL CASAL             

Although drug resistance in tuberculosis is by no means a new problem, multiple drug resistance is a cause of increasing concern. This study investigated first-line drug resistance in Mycobacterium tuberculosis strains isolated in a hospital environment and strains submitted as the Reference Center from 2000 to 2010. A total of 650 cultures were tested against first-line using the BACTEC MGIT 960 system. Resistance to first-line drugs was detected in 142 strains, (21.85%). A total of 2% were multiresistant (MDR). Of the strains resistant to first-line drugs, the greatest resistance was found to isoniazid (7.38 %) followed by rifampin and streptomycin (3.85%), pyracinamide (2%), and ethambutol 1.23%. Only one strain was resistant to four drugs. Values. In view of the resistance observed, careful surveillance of drug resistance is recommended.

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