Rev Esp Quimioter 2015:28(1):21-28

Acceptability of the HPV vaccine among Spanish university students in the pre-vaccine era: a cross-sectional study                                 
 


PABLO CABALLERO-PÉREZ, JOSÉ TUELLS, JOSEBA REMENTERÍA, ANDREU NOLASCO, VICENTE NAVARRO-LÓPEZ, JAVIER ARÍSTEGUI              

Introduction. Cervical cancer (CC), the second most common cause of cancer deaths in women, is associated with the infection of human papillomavirus (HPV) and is more prevalent in women between the ages of 20 and 24. This research is aimed to determine the background about CC, the human papillomavirus infection and its vaccine, assessing its acceptability in university students.
Methods. Cross-sectional study over 1,750 students from the University of Alicante (2008) selected at random, proportional associated to gender and studies, by a validated ad-hoc questionnaire. Percentages were computed, confidence intervals, contingency tables according to sex, age and type of studies, calculating adjusted odd ratios (OR).
Results. A sample with 58.6 % of women and 6.6% of biohealth students was obtained. 87.3% were willing to have the vaccine to prevent human papillomavirus (HPV), 94.3% would give this vaccine to their daughters, and 48.0% had heard someone talk about the vaccine. 90.6% didn´t have a lot of knowledge about the HPV infection and 82.2% didn´t know much about the vaccine. 22.4% had knowledge of the association between HPV and CC. Women register higher OR in acknowledging the problem and are more receptive to having the vaccine. The HPV vaccine acceptability is associated to the sex, the confidence of vaccines as a preventive method; the influence of the background is low in relation to the vaccine predisposition.
Conclusions. A high acceptability of the vaccine was observed in the period of the study. Raising confidence in people about the vaccines can influence for a better predisposition to be vaccinated.

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Rev Esp Quimioter 2015:28(3):157-159

New methodological advances: algorithm proposal for management of Clostridium difficile infection                                 
 


MARÍA JOSÉ GONZÁLEZ-ABAD,  MERCEDES ALONSO-SANZ              

 


Introduction. Clostridium difficile infection (CDI) is considered the most common cause of health care-associated diarrhea and also is an etiologic agent of community diarrhea. The aim of this study was to assess the potential benefit of a test that detects glutamate dehydrogenase (GDH) antigen and C. difficile toxin A/B, simultaneously, followed by detection of C. difficile toxin B (tcdB) gene by PCR as confirmatory assay on discrepant samples, and to propose an algorithm more efficient.
Material and Methods. From June 2012 to January 2013 at Hospital Infantil Universitario Niño Jesús, Madrid, the stool samples were studied for the simultaneous detection of GDH and toxin A/B, and also for detection of toxin A/B alone. When results between GDH and toxin A/B were discordant, a single sample for patient was selected for detection of C. difficile toxin B (tcdB) gene.
Results. A total of 116 samples (52 patients) were tested. Four were positive and 75 negative for toxigenic C. difficile (Toxin A/B, alone or combined with GDH). C. difficile was detected in the remaining 37 samples but not toxin A/B, regardless of the method used, except one. Twenty of the 37 specimens were further tested for C. difficile toxin B (tcdB) gene and 7 were positive.
Discussion. The simultaneous detection of GDH and toxin A/B combined with PCR recovered undiagnosed cases of CDI. In accordance with our data, we propose a two-step algorithm: detection of GDH and PCR (in samples GDH positive). This algorithm could provide a superior cost-benefit ratio in our population.

 

Rev Esp Quimioter 2015:28(3):157-159 [pdf]

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Rev Esp Quimioter 2015:28(Suppl. 1):34-37

Management of invasive candidiasis in non-neutropenic patient     

                        
 CELIA CARDOZO, JOSÉ MENSA              

Among the most frequents etiological agents that causing nosocomial infections, there is included Candida spp. Candida’s bloodstream infection mortality rates are over 30%. Antifungal early treatment is essential to improve the prognosis of this type of infection. Because of the lack of fast enough microbiological tests for early diagnosis, treatment must necessarily be initiated empirically.

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Rev Esp Quimioter 2015:28(6):302-309

Use of antibiotics at a University Clinic Hospital: effect of protocolized antibiotic treatment in the evolution of hospital patients with infections     

                        
JOAQUÍN GÓMEZ-GÓMEZ, ELISA GARCÍA-VÁZQUEZ, CRISTINA BONILLO, ALICIA HERNÁNDEZ-TORRES, MANUEL CANTERAS-JORDANA              

Objectives. To analyse factors associated to “failure” in patients under antibiotic (AB) treatment at a third level hospital.
Patients and methods. All patients receiving an AB treatment along April 2012 were prospectively observed and factors associated to failure were analyzed. Failure was defined as clinical or microbiological failure, relapse or death. Statistically significance was established as p<0.05.
Results. 602 of 1,265 admitted patients during the study month included an AB in their medical prescriptions, being 178 considered as prophylactic AB prescriptions, 342 empirical treatments and 82 directed treatments as empiric treatments. Ceftriaxone and levofloxacin were the most used AB; choice of empirical and directed treatments were in line with protocols in 71% (242 of 342 cases) and 67% (55 of 82), respectively. Of all the patients receiving antibiotics for therapy (n=424), 402 had infection criteria (in 22 cases antibiotic treatment was deemed unnecessary since the patient showed no infectious process). Of these, 292 (72%) showed a good evolution, while the others were considered as failed therapies, either because of microbiological persistence in 49 (12.8%), relapse in 31 (7.71%) and death in en 30 (7.46%). Factors associated to “failure” were Charlson score ≥3 (OR 3.35; 95%CI 1.602-7.009); empirical and/or directed treatment not in keeping with the protocol (OR 5.68; 95%CI 2.898-11.217); and infection by ESBL and/or ciprofloxacin resistant E. coli (OR 4.43; 95%CI 1.492-13.184).
Conclusions. A high rate of AB prescriptions in admitted patients correspond to empirical infection treatment,  being ceftriaxone and levofloxacin the most used AB. Inadequate empirical and/or directed treatment is associated to clinical or microbiological failure and death.

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Rev Esp Quimioter 2015:28(1):29-35

Prevalence of serotypes causing invasive pneumococcal disease in the region of Tarragona, Spain, 2006-2009: vaccine-serotype coverage for the distinct antipneumococcal vaccine formulations                                 
 


OLGA OCHOA-GONDAR, FREDERIC GÓMEZ-BERTOMEU, ANGEL VILA-CÓRCOLES, XAVIER RAGA, CARLOS AGUIRRE, JESÚS UTRERA, CINTA DE DIEGO, JORGE A. GUZMÁN, ENRIC FIGUEROLA Y GRUPO DE ESTUDIO EPIVAC              

Background. Pneumococcal infections remain a major health problem worldwide. This study analysed the distribution of distinct Streptococcus pneumoniae serotypes causing invasive pneumococcal disease (IPD) among all-age population in the region of Tarragona (Spain) throughout 2006-2009.
Methods. An amount of 237 strains were evaluated, of which 203 (85.7%) were isolated from blood cultures, 14 (5.9%) from pleural fluids, 13 (5.5%) from CSF samples and 7 (3%) from other sterile sites. Forty-seven cases (19.8%) were children ≤14 years, 94 (39.7%) were patients 15-64 years and 96 (40.5%) were patients ≥65 years.
Results. Seven serotypes (1, 3, 6A, 7F, 12F, 14 and 19A) caused almost two thirds (63.3%) of cases among all-age patients. Serotype 1 was the most common serotype among children (44.7%) and among people 15-64 years (21.3%), whereas serotype 19A was the most common among people ≥65 years (12.5%).Among all-age population, serotype-vaccine coverage for the distinct pneumococcal polysaccharide vaccine (PPV) and conjugate vaccines (PCVs) were 17.3% for the PCV7, 49.8% for the PCV10, 73% for the PCV13 and 80.2% for the PPV23 (p<0.001). Among children, vaccine-serotype coverage was 23.4% for the PCV7, 72.3% for the PCV10 and 83% for the PCV13. Among people ≥65 years, vaccine-serotype coverage was 62.5% for the PCV13 and 68.8% for the PPV23.
Conclusion. A considerable proportion of IPD cases among our population would not be covered by the current pneumococcal vaccines.

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Rev Esp Quimioter 2015:28(4):169-182

Clinical usefulness of triazole derivatives in the management of fungal infections                                 
 

ALFONSO JAVIER CARRILLO-MUÑOZ, GUSTAVO GIUSIANO, ALICIA ARECHAVALA, CRISTINA TUR-TUR, ELENA ERASO, NEREA JAUREGIZAR, GUILLERMO QUINDÓS, RICARDO NEGRONI              

Current therapy for mycoses is limited to the use of a relative reduced number of antifungal drugs. Although amphotericin B still remains considered as the “gold standard” for treatment, acute and chronic toxicity, such as impairment of renal function, limits its use and enhances the investigation and clinical use other chemical families of antifungal drugs. One of these chemical class of active drugs are azole derivatives, discovered in 70s and introduced in clinical practice in 80s. Being the most prolific antifungal class, investigation about more molecules, with a safer and better pharmacological profile, active against a wide spectrum of fungi, with a wide range of administration routes gives us some azole representatives.

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Rev Esp Quimioter 2015:28(Suppl. 1):38-42

Filamentous fungal infections in immunosuppressed patients: prophylaxis and treatment     

                        
 ISABEL RUIZ-CAMPS, MADDALENA PEGHIN              

Although the incidence of invasive aspergillosis has decreased in haematologic patients and solid organ transplant recipients due to the use of prophylaxis; aspergillosis has emerged in other populations undergoing immunosuppressive drugs where prophylaxis is not well defined presenting different clinical patterns. Voriconazole is the gold standard in the treatment of aspergillosis and probably combined therapy, with voriconazole plus anidulafungin, could have a role in the initial management of the infection.

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Rev Esp Quimioter 2015:28(6):310-313

Clinical features and outcomes of aspiration pneumonia and non-aspiration pneumonia in octogenarians and nonagenarians admitted in a General Internal Medicine Unit     

                        
HÉCTOR PINARGOTE, JOSE MANUEL RAMOS, ALINA ZURITA, JOAQUÍN PORTILLA              

Introduction. Pneumonia is a common infectious disease and causes significant morbidity and mortality especially in elderly people. Aspiration as a cause of pneumonia is common in this population. The aim of our study was to describe the clinical features and outcomes of very old patients with aspiration pneumonia (AP) and comparing them with patients with non-AP. 
Material and methods. In this prospective cohort study, we analyzed old patients (≥80 years-old) with pneumonia admitted 2014 in the Department of General Internal Medicine.
Results. Seventy-six old patients with pneumonia were included in the study, and 46 (60.5%) met criteria of AP. Increasing levels of urea, creatinine and sodium and low estimated glomerular filtrate rate were more common among AP patients. In addition, severity of pneumonia scored by pneumonia severity index and CURB-65 score were significantly greater in AP than in non-AP patients. The 30-days mortality in AP was (44%) quite higher than in non-AP (32%). The only predictor of mortality was high level of sodium (odds ratio: 1.09; 95% confidence intervals: 1.00-1.18).
Conclusions. AP in octogenarian and nonagenarians showed higher levels of sodium and low estimated glomerular filtrate rate and higher severity of pneumonia and slightly higher mortality than non-AP.

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Rev Esp Quimioter 2015:28(1):36-38

Salmonella enterica with nonclassical quinolone resistance phenotype in pediatric patients                                 
 


Mª JOSÉ GONZÁLEZ-ABAD, MERCEDES ALONSO-SANZ              

 

Introduction. Decreased susceptibility to fluoroquinolones in Salmonella spp. may lead to treatment failures. The use of ciprofloxacin for extraintestinal and serious intestinal Salmonella infections in children is controversial and therefore the clinical relevance of these strains is not significant. Consequently little is know about the quinolone resistance of strains Salmonella of our paediatric population. The objective of this study was to assess the incidence of nonclassical quinolone resistance phenotype in paediatric patients.
Material and methods. Two hundred and sixty eight Salmonella spp. from Hospital Infantil Universitario Niño Jesús of Madrid (2009-2013) were tested against nalidixic acid and ciprofloxacin by microdilution. Moreover, 146 strains (2011-2013) were tested against ciprofloxacin by E-test. Reduced ciprofloxacin susceptibility was defined as a MIC of 0.125-1 mg/L.
Results. Of 42 isolates with reduced ciprofloxacin susceptibility, four isolates showing nonclassical quinolone resistance phenotype. Three were confirmed as carrying of plasmid-mediated quinolone resistance-conferring genes qnr.
Conclusions. The percentage of strains with a genotype that confers a nonclassical quinolone resistance phenotype is low in our series. The identification of these isolates is difficult using conventional methods, but its ability of horizontal spread recommends an appropriate identification. Taking into account the low isolation rate of these strains in this study, evaluation of ciprofloxacin MIC on every nalidixic acid susceptible strain would not be cost effective. Alternatively, we propose to evaluate periodically any changing trend.

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Rev Esp Quimioter 2015:28(4):183-192

Variability in antibiotic consumption within a regional health service, according to health area and model of healthcare coverage: national health system vs. civil servants’ mutual insurance society                                 
 

DIEGO PABLO SÁNCHEZ-MARTÍNEZ, JOSÉ JESÚS GUILLÉN-PÉREZ, FERNANDO IGNACIO SÁNCHEZ-MARTÍNEZ, ALBERTO MANUEL TORRES-CANTERO              

Introduction. The aim of this study is to describe antibiotic consumption in the Region of Murcia in 2011, within the Spanish and European context, as well as to analyze the differences within the Region, both between health areas, and between users of the regional health service and those protected by the civil servants’ mutual insurance society (MUFACE).
Methods. Retrospective observational study of prescriptions dispensed by the pharmacies in the Region of Murcia during 2011. Consumption rates were expressed as defined daily doses (DDD) per 1,000 inhabitants/day and standardized consumption ratios (SCR).
Results. Overall antibiotics consumption rate in the Region of Murcia in 2011 was 30.05 DDD/1000/ day (DID), which is much above the average rate for Spain (20.9 DID) and for the European Union (21.57 DID). Health areas within the Region with the highest and lowest consumption rate are, respectively, Vega Alta (SCR: 124.44; CI95% 124.26 to 124.61) and Cartagena (SCR:84.16; CI95% 84.10 to 84.22). Civil servants covered by the mutual society have higher consumption rates than users of the regional health service (SCR: 105.01; CI95% 104.86 to 105.17).
Conclusions. There is a high level of antibiotic prescription in the Region of Murcia Region in relative terms. A great variability in antibiotics consumption was observed between the different health areas, which might be related to the higher rate of the frequency of visits. The highest amount of variability in antibiotics prescription was found in cephalosporins and macrolides.

Rev Esp Quimioter 2015:28(4):183-192 [pdf]

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