Rev Esp Quimioter 2015:28(Suppl. 1):48-51

Therapeutic update in hepatitis C     

                        
 MARÍA JOSÉ DEVESA, FRANCISCA CUENCA, SONIA IZQUIERDO, PILAR SÁNCHEZ-POBRE, JOSÉ MARÍA LADERO, GUSTAVO LÓPEZ-ALONSO, MANUEL DÍAZ-RUBIO, ENRIQUE REY              

Hepatitis C virus infection is a major health burden affecting 130-170 million people worldwide. Approximately 10-30% of those with chronic hepatitis C will progress to cirrhosis over 20-30 years. The development of new direct-acting antivirals has changed the management of the disease, allowing efficacious Interferon-free therapies superior to prior treatment regimens with minimal side effects, even in some subgroups previously thought to be difficult to cure such as cirrhotic patients.

Rev Esp Quimioter 2015:28(Suppl. 1):48-51 [pdf]

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Rev Esp Quimioter 2015:28(Suppl. 1):52-53

Optimization strategies in management of CMV infection in transplant patients     

                        
 DAVID NAVARRO              

Currently, two therapeutic strategies are applied for preventing the development of CMV end-organ disease in transplant recipients: universal prophylaxis and preemptive antiviral therapy. Both are potentially optimable. As for the former strategy,  precisely identifying patients at greatest risk of viremia would allow for a targeted prophylaxis. In this sense several genotypic, immunological and biological markers have been described that could be ancillary to that purpose. As for the latter strategy, combined monitoring of plasma CMV DNA load and peripheral levels of CMV-specific CD8 + and CD4 + IFN-γ producing T cells would permit a more rationale use of antivirals, thus avoiding overtreatment and derived toxicity.

Rev Esp Quimioter 2015:28(Suppl. 1):52-53 [pdf]

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Rev Esp Quimioter 2015:28(Suppl. 1):54-56

Is it possible to cure HIV infection?     

                        
 CAROLINA GUTIÉRREZ, NADIA P. MADRID, SANTIAGO MORENO              

Antiretroviral therapy has significantly improved the life expectancy in HIV-infected people, but it cannot cure the disease by itself. Several barriers have been identified for the cure of HIV infection, including a reservoir of latently infected cells, persistent viral replication in tissues, and anatomical sanctuaries. The main strategy proposed for the cure of HIV consists on the administration of drugs that, through the reactivation of latent HIV, would eliminate the cell reservoir. Ongoing clinical trials have shown the proof of concept, but the efficacy of these drugs in decreasing the reservoir size has not been proved so far.

Rev Esp Quimioter 2015:28(Suppl. 1):54-56 [pdf]

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Rev Esp Quimioter 2015:28(5):225-234

Noma/Cancrum oris: a neglected disease     

                        
MARÍA GARCÍA-MORO, ENRIQUE GARCÍA-MERINO, ÁNGEL MARTÍN-DEL-REY, ENRIQUE GARCÍA-SÁNCHEZ, JOSÉ ELÍAS GARCÍA- SÁNCHEZ              

Noma is an aggressive orofacial gangrenous pathology that damages hard and soft tissues of the mouth and the face. Throughout the centuries it has been present around the globe, but nowadays it has practically disappeared from developed countries and mainly affects children from the most disadvantaged places, especially in Africa. Noma disease is a multifactorial process; malnutrition, debilitating diseases (bacterial or viral systemic diseases, HIV-associated immunosuppression, etc.) and intraoral infections are some of the factors implied. The characteristic tissue necrosis is produced by a polymicrobial infection. Fusobacterium necrophorum, Prevotella intermedia, Prevotella melaninogenica, Fusobacterium nucleatum, Bacteroides fragilis, Bacillus cereus, Trueperella pyogenes, spyrochetes, etc, are some of the species that have been isolated from the affected areas. Without treatment, noma is lethal in a short period of time, and the patients that survive show severe sequelae that hinder their life and interpersonal relationships. The aim of this paper is to unify the existing information and to promote wider knowledge and awareness among the population.

Rev Esp Quimioter 2015:28(5):225-234 [pdf]

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Rev Esp Quimioter 2015:28(Suppl. 1):5-7

Applicability of new diagnostic techniques in microbiology; technological innovation     

                        
RAFAEL CANTÓN, ELENA LOZA, JOSÉ ROMERO              

Different new techniques have been introduced in microbiology laboratories during the last years, including mass spectrometry and next generation sequencing. These techniques, in addition to automation, microfludics, nanotechnology and informatics, have impelled innovation in the prevention and management of patients with infectious diseases. These approaches are relevant for revitalization and consolidation Clinical Microbiology laboratories.

Rev Esp Quimioter 2015:28(Suppl. 1):5-7 [pdf]

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Rev Esp Quimioter 2015:28(5):242-246

Vitek MS matrix-assisted laser desorption ionization-time of flight mass spectrometry for identifying respiratory bacterial pathogens: a fast and efficient method     

                        
Mª FÁTIMA LÓPEZ-FABAL, JOSÉ LUÍS GÓMEZ-GARCÉS, JOSÉ LUÍS LÓPEZ-HONTANGAS, NURIA SANZ, CARMEN MUÑOZ, MARTA REGODÓN              

Mass spectrometry has become a reference resource for identifying microorganisms in clinical microbiology services. One hundred and fifty one clinical isolates were selected from respiratory specimens routinely identified as Streptococcus pneumoniae (43), Haemophilus influenzae (64) and Moraxella catarrhalis (44). These identifications were compared with other phenotypical methods and mass spectrometry (MALDI-TOF-MS Vitek). Result discrepancies were assessed by 16S rRNA sequencing. Thirty-eight of the 43 strains of S. pneumoniae (86%) were identified as such using phenotypical methods and spectrometry. In 5 cases, MALDI-TOF identified 4 of them as Streptococcus pseudopneumoniae and 1 as S. mitis/oralis. Forty-eight of the 64 strains were identified as H. influenzae (75%) using biochemical identification systems and automated identification systems, whereas MALDI-TOF-MS Vitek identified 51 strains (79%) as such. Conventional methods and spectrometry identified all the 40 strains tested (100%) as M. catarrhalis. All strains with discrepant results were sequenced, and in all cases, the identification obtained by spectrometry was confirmed. The results obtained in this study show that mass spectrometry provides identification of these bacteria faster and in a more reliable way than those based on conventional phenotypical methods.

Rev Esp Quimioter 2015:28(5):242-246 [pdf]

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Rev Esp Quimioter 2015:28(5):247-255

A two-hour procedure for determining the susceptibility of enterococci and staphylococci to antibiotics by a colourimetric method     

                        
GABRIEL ALBERTO MARCH-ROSSELLÓ, MARÍA PURIFICACIÓN GUTIÉRREZ-RODRÍGUEZ, MARÍA SIMARRO-GRANDE, ANTONIO ORDUÑA-DOMINGO, MIGUEL ÁNGEL BRATOS-PÉREZA              

Introduction. Rapid determination of the antibiotic susceptibility test in bacteria remains a challenge for Clinical Microbiology laboratories.
Methods. An improvement in the colorimetric antimicrobial susceptibility testing performed with resazurin in enterococci and staphylococci has been carried out. The design of method was performed using two collection strains, which have a known susceptibility. This procedure was then validated against standard commercial methods on 15 strains of staphylococci and 15 strains of enterococci from patients.
Results. The essential agreement between the colorimetric method and commercial methods (E-test, MicroScan and VITEK2) was 100%.
Conclusion. Resazurin allows us to obtain a reliable antibiotic susceptibility test in staphylococci and enterococci in less than two hours.

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Rev Esp Quimioter 2015:28(5):256-262

Bacteraemia due to extended-spectrum beta-lactamases (ESBL) and other beta-lactamases (ampC and carbapenemase) producing Enterobacteriaceae: association with health-care and cancer)     

                        
MIRIAM GARCÍA-GÓMEZ, LAURA GUÍO, JOSÉ LUIS HERNÁNDEZ, BEGOÑA VILAR, JOSÉ IGNACIO PIJOÁN, JOSÉ MIGUEL MONTEJO              

Introduction. Bloodstream infections due to multire-sistant Enterobacteriaceae are a major matter of concern nowadays. The present study evaluated the impact of these infections in our area.
Methods. Prospective observational study of a cohort of patients with bacteraemia due to extended-spectrum beta-lactamases (ESBL) and other beta-lactamases producing organisms among hospitalized patients in Cruces Hospital for 2 years. We conducted a descriptive analysis, a subgroup analysis (cancer vs. non-cancer patients) and a mortality analysis.
Results. During the study period, 3409 episodes of bacteraemia were diagnosed, of which 124 (3.6%) were ESBL and other beta-lactamases producing Enterobacteriaceae. 40.3% of the cases were nosocomial, 15.3% community acquired and 44.4% were health-care associated. 44.4% of the cohort had cancer as underlying disease. The most commonly isolated organism was E. coli (83% of cases), regardless of the source of infection. 58.1% of patients received inadequate empirical therapy. 7 day-mortality was 10.5% and 30 day-mortality was 21.8%. None of the analyzed variables showed association with 7 and 14 day-mortality, but the presence of solid cancer (p= 0.032) and advanced HIV infection (p = 0.027), were significantly associated with higher 30 day-mortality.
Conclusions. More than half of bacteraemia episodes affected outpatients and most of them were health-care associated episodes. Even though more than half of the patients received inadequate empirical treatment, this was not related to higher mortality. We only found an association between 30 day-mortality and the presence of underlying solid malignancy or advanced HIV infection.

Rev Esp Quimioter 2015:28(5):256-262 [pdf]

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Rev Esp Quimioter 2015:28(5):263-266

Evaluation of antibiotic resistance of Escherichia coli in urinary tract infections in Primary Care Barbastro Sector (Huesca)     

                        
ANA BETRÁN, ANA Mª CORTÉS, CONCEPCIÓN LÓPEZ              

Objectives. Evaluate the resistance of community-uropathogen, Escherichia coli to several antibiotics in our health sector and deduce empirical treatment options.
Methods. E. coli strains isolated from urine cultures of patients from Primary Care Barbastro Sector, between January 2011 and December 2013, were studied. The resistances rates for nine common antibiotics were determined, and differences in sensitivity were analyzed, comparing confidence intervals for proportions by the method of Wilson.
Results. E. coli was the most frequently isolated bacteria (61.08% of positive urine cultures sent from Primary Care). Overall, there has been an increase in resistance of E. coli isolates in all antimicrobials studied. Still, resistance has remained below 4% compared to fosfomycin and nitrofurantoin and below 10% in cephalosporins second and third generation. Resistance to amoxicillin-clavulanate has increased progressively reaching 21.5% in 2013; only this antibiotic has presented a statistically significant increase. The maximum levels of resistance (over 30%) were found in the antibiotics administered orally and often indicated in uncomplicated urinary tract infections: trimethoprim-sulfamethoxazole, ciprofloxacin and ampicillin.
Conclusions. Update knowledge susceptibility patterns of microorganisms most commonly isolated in urine samples in each health area allows to choose the most suitable and effective treatments trough empirical knowledge.

Rev Esp Quimioter 2015:28(5):263-266 [pdf]

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Rev Esp Quimioter 2015:28(6):275-281

Liposomal formulations of amphotericin B: differences according to the scientific evidence     

                        
JOSÉ RAMÓN AZANZA, BELÉN SÁDABA, JOANA REIS              

This article presents an overview of the characteristics of liposomes as drug carriers, particularly in relation to liposomal formulations of amphotericin B. General features regarding structure, liposome-cell interactions, stability, encapsulation of active substances and elimination of liposomes are described. Up to the present time extensive efforts to produce similar or bioequivalent products of amphotericin B formulations, in particular in the case of liposomal amphotericin B, have been unsuccessful in spite of having a very similar composition and even an apparently identical manufacturing process. Guidelines for the development of generic liposomal formulations developed by the FDA and EMA are also summarized. Based on the available evidence of the composition of liposomes, any differences in the manufacturing process even if the same lipid composition is used may result in different final products. Therefore, it seems unreasonable to infer that all amphotericin B liposomal formulations are equal in efficacy and safety.

Rev Esp Quimioter 2015;28(6):275-281 [pdf]

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