Rev Esp Quimioter 2015:28(1):10-20

Prevention of an outbreak of Acinetobacter baumannii in intensive care units: study of the efficacy of different mathematical methods                                 
 


MARÍA JOSÉ FRESNADILLO-MARTÍNEZ, ENRIQUE GARCÍA-MERINO, ENRIQUE GARCÍA-SÁNCHEZ, ÁNGEL MARTÍN-DEL REY, ÁNGEL RODRÍGUEZ-ENCINAS, GERARDO RODRÍGUEZ-SÁNCHEZ, JOSÉ ELÍAS GARCÍA-SÁNCHEZ              

Introduction. Although in past decades, Acinetobacter baumanni infections have been sporadically identified in hospitals, nowadays the nosocomial infections due to this pathogen have notably increased. Its importance is due to its multidrug-resistance, morbidity and mortatility in healthcare settings. Consequently, it is important to predict the evolution of these outbreaks in order to stablish the most efficient control measures. There are several experimental studies shown that the compliance with hand and environmental hygiene and the efficient management of the healthcare work help to control the evolution of these outbreaks. The goal of this work is to formally proof these experimental results by means of the analysis of the results provided by the model.
Methods. A stochastic mathematical model based on cellular automata was developed. The variables and parameters involved in it have been identified from the knowledge of the epidemiology and main characteristics of Acinetobacter infections.
Results. The model provides several simulations from different initial conditions. The analysis of these results proofs in a formal way that the compliance with hand and environmental hygiene and an efficient plannification of the work of healtcare workers yield a decrease in the colonized patients. Moreover, this is the unique model proposed studying the dynamics of an outbreak of A. baumanni.
Conclusions. The computational implementation of the model provides us an efficient tool in the management of outbreaks due to A. baumanni. The analysis of the simulations obtained allows us to obtain a formal proof of the behaviour of the measures for control and prevention.

Rev Esp Quimioter 2015:28(1):10-20 [pdf]

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Rev Esp Quimioter 2015:28(3):154-156

Nebulized medication is not associated with nosocomial infections. A pilot study                                 
 


DAVID VINUESA, VIOLETA RAMOS, ALEJANDRO PEÑA, MARÍA RUIZ-RUIGÓMEZ, JON BADIOLA, LEOPOLDO MUÑOZ-MEDINA, JOSÉ HERNÁNDEZ-QUERO, JORGE PARRA-RUIZ              

 

Introduction. Nebulized devices are commonly used in the treatment of respiratory infection, and other respiratory diseases. It has been reported nosocomial infections in cystic fibrosis patients as a result of the use of contaminated devices. However, little is known about nosocomial infections secondary to aerosolized therapy in COPD patients admitted for acute exacerbation.
Methods. Thirty consecutive patients (13 males) were included. All of them received aerosolized medication.  Each patient used their own facemask and nebulizer cup, which were stored in the room after its use. Samples from nebulizer cups were obtained on days 0, 4 and 7. In addition, sputum samples were obtained on day 0 (prior to any nebulization) and on day 7, and cultivated in enriched media.
Results. Only nine nebulizer cups had positive microbiological cultures. Coagulase negative staphylococci (CoNS) were isolated in all cases. Sputum samples could be obtained in 27 patients. None grew CoNS after 7 days of aerosolized therapy. Gram-negative non-fermenting bacilli were isolated in three patients without concomitant grown in nebulizer cups.
Conclusions. We did not find any nosocomial infection related to aerosolize medications in COPD patients admitted for acute exacerbation.

 

Rev Esp Quimioter 2015:28(3):154-156 [pdf]

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Rev Esp Quimioter 2015:28(Suppl. 1):30-33

Duration of antimicrobial therapy     

                        
JUAN PASQUAU, MAYRA MATESANZ              

The management of infectious diseases is always complex, not only because of its high incidence and mortality, but the difficulty of designing effective treatments that minimize the development of bacterial resistance in the clinical setting. One of the most important options is the reduction of exposure to antibiotic treatment, optimizing by desescalation and shortening the duration of therapy.

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Rev Esp Quimioter 2015:28(6):295-301

Analysis of the concordance of antibiotic treatment for patients with severe sepsis in emergencies     

                        
MARÍA ANTONIA PÉREZ-MORENO, BEATRIZ CALDERÓN-HERNANZ, BERNARDINO COMAS-DÍAZ, JORDI TARRADAS-TORRAS, MARCIO BORGES-SA              

Objectives. Antibiotic treatment is vital in patients with severe sepsis/septic shock. The objectives were to assess the degree of concordance between antibiotic prescribed in emergencies and post requirements; to relate it to health outcomes (mortality) and to analyze the reasons for disagreement.
Material and methods. Retrospective descriptive study of antibiotic treatment prescribed in emergencies and the subsequent treatment in patients with criteria of severe sepsis/septic shock in 2013. We collected patient demographic characteristics, infectious focus, antibiotic prescribed from emergencies and subsequent changes. It was considered concordant if there were no changes, if there were changes, but the initial antibiotic was right and suspensions for end of treatment. Mortality and evolution were analyzed.
Results. Six hundred patients were included. A 60% experienced changes respect to the antibiotic treatment initiated in emergencies (87.6% justified), with a degree of overall antibiotic concordance of 47.5% The mortality rate at end-point was 9.83%, with no statistically significant relationship with the degree of concordance (OR=0.864 (0.503-1.484)/χ2=0.28; p=0.597). Reasons for change of antibiotic:  clinical outcome (17.96%), change of spectrum (35.03%), de-escalation (41.32%), sequential therapy (8.68%). An 11% required ICU admission. Clinical outcomes: resolution of the disease (79.2%), readmission after 30 days (7.7%) and transfer to health centers (4.5%). The median hospital stay was 7 days.
Conclusions. The degree of concordance antibiotic was quite high, and the mortality rate was lower than that described in the literature, without relating to the discordance. The presence of concordance was associated with fewer readmissions and ICU admissions. The main reasons for disagreement were inadequate spectrum selection and change after microbiological crops.

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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.

 

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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.

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

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