Rev Esp Quimioter 2014:27(2):93-97

Reasons for antiretroviral treatment change in HIV+ patients in Spain in 2010-2011. SWITCH AUDIT Study                                 
 

ENRIC PEDROL, POMPEYO VICIANA, ALBERTO ARRANZ, JUAN PASQUAU, ELISABETH DEIG, MARIONA TASIAS Y EL GRUPO DE ESTUDIO SWITCH AUDIT               

Survey in 349 HIV infected subjects in 19 Spanish Hospitals in 2010-2011, to assess the reasons for antiretroviral treatment change. Simplification was the most frequent reason for change (37%), followed by toxicity (30%) and treatment failure (21%). There were statistically significant differences according to treatment line and transmission category. In conclusion, in many patients treatment is changed in order to obtain the benefits of a regimen easier to follow.

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Rev Esp Quimioter 2014:27(4):261-268

Trend in the susceptibility of the most frequent bacterial pathogens isolated at Hospital General La Mancha Centro over 2010-2012 period                                 
 


MARÍA ÁNGELES ASENCIO, MARÍA HUERTAS, RAFAEL CARRANZA, MARÍA FRANCO, JESÚS CASTELLANOS, JOSÉ RAMÓN BARBERÁ, MARÍA DEL CARMEN CONDE, JOSÉ MARÍA TENÍAS              

Introduction. Our objective was to determine the trend of the antimicrobial susceptibility of the most common bacterial
pathogens isolated in La Mancha Centro Hospital (MCH) between 2010-2012.
Material and methods. Isolates of Staphylococcus aureus, Escherichia coli, Klebsiella pneumoniae and Pseudomonas aeruginosa from patients admitted to MCH were studied. These data and their antibiotic susceptibility were obtained from the database OBSERVA (BioMérieux).
Results. The percentages of susceptibility for S. aureus were: 50% methicillin-resistant-S. aureus (MRSA) (higher co-resistance to erythromycin and levofloxacin), 46% erythromycin, 73% clindamycin, 45% levofloxacin, 99% rifampin and 100% cotrimoxazole, glycopeptides, linezolid and daptomycin. Increased resistance in ICU was observed (63% MRSA), with 50% of S. aureus (susceptible and methicillin-resistant strains) with vancomycin MIC values ≥ 0.5 mg/L. E. coli susceptibility: 62% amoxicillin-clavulanate, 55% ciprofloxacin, 60% cotrimoxazole, 84% gentamicin and 95% fosfomycin. K. pneumoniae susceptibility: 74% amoxicillin-clavulanate, 71% ciprofloxacin, 78% cotrimoxazole, 94% gentamicin and 87% fosfomycin. The percentage of BLEE strains was 17% and 21% for E. coli and K. pneumoniae, respectively, without detection of resistance to carbapenems. P. aeruginosa susceptibility: 80% ceftazidime and carbapenems, 63% ciprofloxacin and higher than 90% aminoglycosides. A decreasing trend of susceptibility to ceftazidime and carbapenems was observed in ICU and increasing trend to ciprofloxacin.
Conclusions. Resistance percentages were higher in ICU than in the rest of the hospital, highlighting 63% of MRSA strains. Our percentage of BLEE and MRSA strains were higher than the Spanish media. Rifampicin and cotrimoxazole maintain good susceptibility to S. aureus, fosfomycin and aminoglycosides to Enterobacteriaceae and carbapenems to P. aeruginosa.

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Rev Esp Quimioter 2014:27(2):98-101

Seroprevalence of measles, rubella, mumps and varicella in health workers in the Community of Madrid                                 
 

Mª LUISA RODRÍGUEZ, DAVID MARTÍNEZ, JUANA MARÍA SANTOS-SANCHO, JENRY RICARDO BORDA, ANA ORERO               

Background. The vaccination of health workers has a large repercussion on the health of the workers, the patients and the population in general. Due to this, we proposed to discover the serological status for varicella, rubella, mumps and measles in the workers of a tertiary hospital in Madrid.
Methods. We have conducted a retrospective epidemiological study of 1060 health workers, obtaining information such as age, sex, service area, employment status, pre-exposure vaccination and post-vaccination serology and vaccination status.
Results. In the population studied, 90.1% were protected against varicella, 65.6% against mumps, 95.6% against rubella and 92.9% against measles. There is no better protection against these illnesses for workers who treat patients directly, workers who treat immunosuppressed patients or for workers in services or units with a higher risk of infection.
Conclusion. There is no better protection against varicella, rubella, mumps and measles for the workers who have higher risk of infection at work; and the workers who treat patients, that if they suffer these diseases, this could put their health at risk.

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Rev Esp Quimioter 2014:27(2):102-105

Sensitivity of three inmunocromathographic tests in faeces samples for Campylobacter and Salmonella detection in comparison to culture                                 
 

Mª DEL CARMEN LIÉBANA-MARTOS,  JOSÉ GUTIERREZ, CRISTINA RIAZZO, JOSÉ Mª NAVARRO               

Introduction. Campylobacter sp. and Salmonella enterica are two of the main organisms causing gastroenteritis in our environment. Immunochromatographic tests for antigen detection performed directly on stool samples for its simplicity and rapid results may make them useful diagnostic elements in the context of primary care.
Method. During October 2012 we selected all feces in which enteropathogenic bacteria are isolated from those received for stool culture in the laboratory of Microbiology of the University Hospital Virgen de las Nieves of Granada. After standard management of faeces samples and isolation of any enteropathogen, the commercial kits: Campy Leti, Ridaquick Campylobacterscreen and Salmonella Leti were tested for simultaneous research of Campylobacter and Salmonella antigens. Sensitivity and specificity were determined.
Results. Two hundred and thirty five stool samples were received in which 8 Salmonella enterica (7 B serogroup and 1 D serogroup), 7 Campylobacter jejuni, 4 Aeromonas hydrophila and 1 Yersinia enterocolitica were isolated. Campy Leti, Ridaquick Campylobacterscreen and Salmonella Leti presented a sensitivity of 100%, 100% and 75%, respectively. Specificities corresponded to 46%, 69% and 100%, respectively.
Conclusion. Immunocromatographic tests can be useful for a first screening of enteropathogen in primary care.

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Rev Esp Quimioter 2014:27(2):106-109

First clinical isolate in Europe of clindamycin-resistant group B Streptococcus mediated by the lnu(B) gene                                 
 

 DAVID M ARANA, BEATRIZ ROJO-BEZARES, CARMEN TORRES, JUAN IGNACIO ALÓS               

We characterize the mechanisms implicated in an unusual phenotype of resistance to macrolides-lincosamides (no halos of inhibition around clindamycin and lincomycin discs, and a 15 mm halo around erythromycin disc) in a Streptococcus agalactiae isolate recovered in Spain. The presence of macrolide or lincosamide resistance genes [erm(A),erm(B), erm(C), erm(T), mef(A), mrs(A), lnu(A), lnu(B), lsa(B), lsa(C) and vga(C)] was investigated by PCR and sequencing. The strain showed a resistant phenotype to erythromycin and clindamycin (MIC = 2 mg/L and MIC = 8 mg/L, respectively) and the presence of lnu(B) and mef(A) genes was demonstrated. Clinical microbiology laboratories should be aware of this unusual phenotype due to the association of two mechanisms mediated by lnu(B) and mef(A) genes. This constitute, to our knowledge, the first report of lnu(B) in S. agalactiae in human isolates in Europe.

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Rev Esp Quimioter 2014:27(2):110-114

Report of 38 cases of tracheobronchitis in non-immunocompromised patients with dual isolation of Aspergillus in lower respiratory tract samples                                 
 

JOSE BARBERÁN, ELOY SÁNCHEZ-HAYA, DANIEL DEL CASTILLO, FRANCISCO SANZ, BERNARDINO ALCÁZAR, EDUARDO MALMIERCA, ON BEHALF OF THE ASP INVESTIGATOR GROUP               

Introduction. Aspergillus tracheobronchitis is an uncommon manifestation of Aspergillus infection. This study retrospectively analysed patients presenting tracheobronchitis among non-neutropenic/non-transplant adult patients with at least two valuable cultures of respiratory samples yielding Aspergillus spp. in Spanish hospitals.
Methods. Clinical records were retrospectively reviewed. Simple tracheobronchitis was considered when the bronchoscopy report described mucosal inflammation and mucus secretions and invasive tracheobronchitis when ulceration and pseudomembrane formation was reported. Cases were considered “proven” (histopathological confirmation) or “probable” aspergillar tracheobronchitis.
Results. A total of 38 cases of tracheobronchitis (26 simple, 12 invasive) were identified, all considered probable aspergillar tracheobronchitis. Patients were elderly (89.5% patients were ≥65 years), males (76.3%), presented advanced COPD (GOLD III+IV in 81.3%) and heart insufficiency (55.3%), with higher APACHE II score in those with invasive tracheobronchitis (10.17±7.38 vs. 4.32±4.39, p=0.019). Up to 50% patients were taking steroids (accumulated doses >100 mg in 89.5% of them) and 34.2% antibiotics pre-admission. Antifungals were administered to 60.5% patients (57.7% with simple and 66.6% with invasive tracheobronchitis). Voriconazole was the most frequent antifungal (alone or in combination): 69.6% in the 23 treated patients (60.0% simple and 87.5% invasive tracheobronchitis). Mortality was 23.7% (15.4% in simple and 41.7% in invasive tracheobronchitis).
Conclusions. The results of the present studty suggest that aspergillar tacheobronchitis should be considered in the differential diagnosis of non-immunocompromised patients with deteriorating chronic airway limitation.

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Rev Esp Quimioter 2014:27(1):1-16

Clinical indications for therapeutic drug monitoring of antifungal agents. In the way for optimizing the treatment of fungal infection                                 
 

EMILIO CENDEJAS-BUENO, MANUEL CUENCA-ESTRELLA, ALICIA GÓMEZ-LÓPEZ               

Therapeutic drug monitoring as a tool in the management of infectious diseases has been introduced in therapy with anti-infective agents for years. Nowadays, it has taken importance in the management of fungal diseases due to the appearance of new antifungal drugs such as new-generation azoles. These azoles have pharmacokinetic characteristics that hinder a proper use to ensure efficacy and minimize toxicity. Monitoring of serum concentrations may help in the better use of these anti-infective agents, as well as in a better management of drug interactions, infectious disease and adverse effects. It has resulted in saving costs of treatment and in avoiding inadequate dosages. This review will attempt to clarify the role of the antifungal agents Therapeutic Drug Monitoring, highlighting the role of azole compounds.

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Rev Esp Quimioter 2014:27(2):115-121

Review of 1.250 episodes of skin and soft tissue infections attended at 49 hospital emergency departments                                 
 

FERRAN LLOPIS, JUAN GONZÁLEZ-CASTILLO, AGUSTÍN JULIÁN-JIMÉNEZ, CARLES FERRÉ, JULIO JAVIER GAMAZO-RÍO, MIKEL MARTÍNEZ Y EL GRUPO DE TRABAJO INFURG-SEMES               

Objetive. To review the prevalence, clinical characteristics, approach and outcome of patients with skin and soft tissue infections (SSTI) evaluated at the Emergency Departments (ED) in Spain.
Methods. A descriptive multicenter cross-sectional analysis in 49 ED of patients with SSTI. Data were collected for age, gender, comorbid conditions, risk factors for multiresistant pathogens, STTI type, sepsis criteria, microbiology, antibiotic treatment, destination and ED mortality.
Results. We documented 1,250 episodes (11% of all infections and 1.6% of all patients seen in ED), mean age 52 years (56% men) and the comorbidities and risk factors for major adverse outcomes were diabetes (15%), heart disease (12%), previous antibiotic therapy (10%) and solid malignancy (5%). 81% of STTI were nonnecrotizing, 3.3% had septic syndrome, in 65% of patients was not practised any microbiological study, and 16% had risk factors for infection for antibiotic-resistant gram-positive bacteria, with adequate empirical antibiotic therapy of 2.5%. 72% of patients were discharged home and 2 died. When comparing STTI discharged home respect those that were admitted, these latter were older patients with more comorbidities and risk factors for multidrug resistance, sepsis and there were more practised cultures (p < 0.05).
Conclusions. The SSTI have a prevalence of 1.6%, representing 11% of visits to the ED for infection. 44% of patients have comorbidity and 16% have risk factors for infection for resistant gram-positive pathogens and they were not made an appropriate antibiotic coverage.

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Rev Esp Quimioter 2014:27(1):17-21

Antifungal susceptibility of clinical isolates of Scopulariopsis species                                
 

VALLE ODERO, LIDIA GARCÍA-AGUDO, INMACULADA GUERRERO, PILAR AZNAR, PEDRO GARCÍA-MARTOS, MANUEL RODRÍGUEZ-IGLESIAS               

Introduction. Scopulariopsis is a common soil saprophyte. In the last years the infections caused by Scopulariopsis species have increased, included superficial and invasive mycoses. This fungi has been reported resistant in vitro to some antifungal agents, although there is little information about this. The aim of the study was to establish in vitro antifungal susceptibility of clinical isolates of Scopulariopsis species against to broad-spectrum antifungal agents.
Methods. A total of 28 Scopulariopsis strains (10 S. brevicaulis, 7 S. koningii, 3 S. acremonium, 3 S. candida, 3 S. flava, 1 S. brumptii and 1 S. fusca) were tested using Sensititre YeastOne and broth microdilution methods to determine the minimum inhibitory concentrations (MICs) to amphotericin B, fluconazole, itraconazole, posaconazole, voriconazole and 5-fluorocytosine, and minimun effective concentration (MECs) to anidulafungin, caspofungin and micafungin.
Results. Our data confirm the high in vitro resistance of Scopulariopsis to antifungal agents. Anidulafungin, caspofungin, micafungin (MICs ≥8 mg/L), 5-fluorocytosine (MICs ≥64 mg/L), and fluconazole (MICs ≥128 mg/L) were inactive in vitro in all species. MICs of amphotericin B (range 2 to ≥8 mg/L) and itraconazole (0.5 to ≥16 mg/L) were high. The best antifungal activity was observed for posaconazole and voriconazole (0.5 to ≥8 mg/L). With Sensititre YeastOne method MICs obtained slightly lower. Scopulariopsis candida, S. flava and S. fusca were the most resistant species, while S. acremonium and S. brevicaulis showed the lowest MICs.
Conclusions. MICs of all tested antifungal agents for Scopulariopsis were very high. Infections caused by Scopulariopsis species may not respond to antifungal treatment. Voriconazole is the drug of choice for treatment. We consider it appropriate to add amphotericin B in serious infections.

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Rev Esp Quimioter 2014:27(2):122-126

Epidemiology of Clostridium difficile-associated disease (CDAD) in Salamanca                                 
 

MARÍA SILLER-RUIZ, NOELIA CALVO-GARCÍA, SARA HERNÁNDEZ-EGIDO, ANA MARÍA-BLÁZQUEZ, MÓNICA DE FRUTOS-SERNA, JOSÉ ELÍAS GARCÍA-SÁNCHEZ               

Introduction. Clostridium difficile infection is considered a major cause of nosocomial diarrhoea in developed countries and is increasingly becoming more important as an etiologic agent of community diarrhoea, also in patients without risk factors.
Method. Beginning in May 2011, the aim of our study is to know the characteristics of patients suffering from C. difficile Associated Disease in Salamanca University Hospital, collecting their data in a survey conducted for this purpose. A case was defined as a patient with compatible clinical and positive microbiological diagnosis.
Results. After 18 months of study, 41 cases had been documented representing an incidence of 1.15 cases per 10,000 patient-days. Patients were hospitalized (37) or health care associated (4), females (54%), age ≥65 years (56%) with prior antibiotic treatment (80%), most had diarrhea after the third day of admission, less than three weeks and without blood. Most were treated with metronidazole alone (78%), 19% with metronidazole and vancomycin, and the remaining percentage was resolved without treatment. Recurrences were about 20% and 7 (17%) died.
Conclusions. The characteristics of our patients with C. difficile – associated disease are the same as those reported by other authors. Local surveillance is important in order to study the endemic and epidemic C. difficile infection. According to published epidemiological changes, we sould be able to develop strategies from the Microbiology laboratories that will improve diagnosis of the disease.

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