Rev Esp Quimioter 2015:28(3):145-153

Profiles and clinical management of hepatitis C patients in Spain: disHCovery study                                 
 


MARÍA BUTI, ALEJANDRO FRANCO, ISABEL CARMONA, JUAN JOSÉ SÁNCHEZ-RUANO, ANDREU SANSÓ, MARINA BERENGUER, LUISA GARCÍA-BUEY, MANUEL HERNÁNDEZ-GUERRA, ROSA MARÍA MORILLAS, FRANCISCO LEDESMA, RAFAEL ESTEBAN, AND THE DISHCOVERY STUDY GROUP      
        

 

Introduction. To assess the clinical profile and management of patients with hepatitis C (HCV) infection in an observational study in Spanish hospitals.
Methods. The study included an initial cross-sectional phase (study phase I), in which investigators at 48 hospitals from 14 Spanish regions collected data from approximately 20 consecutive patients each (a total of 1,000 patients) to assess the general features of HCV-infected patients of any genotype. During the second phase (study phase II), data from 878 patients that were infected exclusively with genotype 1 HCV were assessed retrospectively. Eight pre-defined clinical profiles were established, in order to assess clinical and previous treatments characteristics.
Results. Among the HCV-infected individuals that were analysed during the first part, HCV genotype 1 was found to be predominant (with a prevalence of 76.6%), prevailing the subtype 1b (69.8%), with other significant groups infected by genotype 3 (12.3%) and 4 (7.4%). In the second part of the study, 44% of the HCV genotype 1-infected patients were at a F3/F4 fibrosis stage. 15.9% had never been treated, and previously unsuccessfully treated patients that were no longer receiving anti-HCV treatment accounted for 50.8% of cases. Individuals with a sustained virologic response (SVR) to pre-vious dual therapies (based on Interferon and Ribavirin) were only 14.5% and patients under treatment during the study accounted for the remaining 18.8%. A total of 713 patients (81.2%) in the second phase were not receiving any type of therapy over the period analysed, mainly due to the anticipation of new anti-HCV drugs (41.8%), SVR achievement (17.8%) and unresponsiveness to therapies available at the time of the study (9.5%).
Conclusions. HCV genotype 1, predominately 1b, is the most prevalent type in Spain. Advanced fibrosis or cirrhosis is frequent in this group, mainly patients not yet cured.

Rev Esp Quimioter 2015:28(3):145-153 [pdf]

Rev Esp Quimioter 2015:28(Suppl. 1):25-29

Cloxacillin-susceptible Staphylococcus aureus with high MIC to glycopeptides. Ever we use cloxacillin?     

                        
ALEJANDRA MORALES, ANTONIO LALUEZA, RAFAEL SAN JUAN, JOSÉ MARÍA AGUADO              

Staphylococcus aureus infections are yet an important cause of morbidity and mortality despite of numerous effective anti-staphylococcal antibiotics available. There has been an increasing incidence of methicillin-resistant strains which might have led to a wider use of vancomycin. This seems to ride alongside a covert progressive increase of S. aureus vancomycin minimum inhibitory concentration. In this way, the emergence of vancomycin-intermediate S. aureus (VISA) strains and heteroresistant-VISA has raised concern for the scarcity of alternative treatment options. Equally alarming, though fortunately less frequent, is the emergence of vancomycin-resistant S. aureus. Ultimately, various debate issues have arisen regarding the emergence of S. aureus strains with decreased vancomycin susceptibility, within the range still considered sensitive. These strains have shown a different clinical behaviour regardless of vancomycin use, both in methicillin resistant and sensitive S. aureus. The emergence of increasing vancomycin-resistance in S. aureus isolates, has stirred up the basis of therapeutic approach in staphylococcal infections. There is yet much to explore to better define the impact of higher vancomycin minimum inhibitory concentration in staphylococcal infections.

Rev Esp Quimioter 2015:28(Suppl. 1):25-29 [pdf]

Rev Esp Quimioter 2015:28(6):289-294

Surveillance of resistance of Staphylococcus aureus to antibiotics in Galicia: 2007-2012     

                        
MERCEDES TREVIÑO, ISABEL LOSADA, MARÍA ÁNGELES PALLARÉS, FRANCISCO JOSÉ VASALLO, AMPARO COIRA, BEGOÑA FERNÁNDEZ-PÉREZ, ISABEL PAZ, FERNANDA PEÑA, PATRICIA ALEJANDRA ROMERO, LUCÍA MARTÍNEZ-LAMAS, GAEL NAVEIRA, XURXO HERVADA              

Introduction. Since 2007 the Galician Surveillance Program on Antimicrobial Resistance has been collected data of Staphylococcus aureus susceptibility patterns. The data from 2007 to 2012 have been analyzed and are reported.
Methods. A total of 4,577 different isolates of S. aureus from cerebrospinal fluid and blood cultures were included. The Institutions involved provided the information about the susceptibility patterns, the assay methods used and the interpretative guidelines followed, and demographic data of patients.
Results. The rate of methicillin-resistance S. aureus (MRSA) was 22% in 2007-2010 and 26% in 2011-2012, although in some areas the percentage reached 57% (2007- 2010) or 66% (2011-2012). The higher rates of resistance were found in patients older than 75 years. Gentamycin resistance was less than 9% and for quinolones were about 25%. A strong association between methicillin and quinolone-resistance were observed (91%). The resistance against linezolid and glycopeptides were exceptional.
Conclusions. The percentage of MRSA has evolved slightly along the period of this study reaching no significant differences between Galicia and the global data in Spain in 2012. Nevertheless, there are significant differences among the geographic areas studied. Most MRSA isolates were recovered from hospitalized patients, but an increase in the number of MRSA among outpatients was observed, while old patients from nur-sing homes are included in the outpatient group, so the MRSA rate in this group could be overestimated.

Rev Esp Quimioter 2015;28(6):289-294 [pdf]

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]

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]

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.

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

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.

Rev Esp Quimioter 2015;28(6):295-301 [pdf]

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.

Rev Esp Quimioter 2015:28(1):21-28 [pdf]

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]

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.

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