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.

Rev Esp Quimioter 2015;28(6):310-313 [pdf]

/por

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.

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

/por

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]

/por

Rev Esp Quimioter 2015:28(Suppl. 1):43-47

Update on Ebola virus infection     

                        
 JUAN C. HURTADO, MIGUEL J. MARTÍNEZ              

Ebola virus disease became a major global public health concern after the last outbreak originated in West Africa in 2014. The epidemic has affected 10 countries in 3 continents, with an estimated global mortality of 41%, highlighting how a disease known to be restricted to the African continent can affect directly or indirectly many countries in the world. In this work, we review different aspects of the virus, the disease and the current outbreak.

Rev Esp Quimioter 2015:28(Suppl. 1):43-47 [pdf]

/por

Rev Esp Quimioter 2015:28(6):314-316

Seroprevalence of hepatitis E virus in patients with hepatitis C and / or infected with HIV     

                        
Mª FÁTIMA LÓPEZ-FABAL, JOSÉ LUÍS GÓMEZ-GARCÉS              

Introduction. Hepatitis E virus (HEV) can cause chronic infection and cirrhosis. The seroprevalence data of anti-HEV IgG in the patients infected with HIV or with chronic liver disease are scarce.
Methods. To document the seroprevalence of HEV infection in HIV patients or with chronic liver disease population, a retrospective study in serum samples from 625 patients was carried on: 200 HIV infected, 200 HCV infected, 25 coinfected by HIV and HCV and 200 healthy controls. Anti-HVE IgG antibodies were determined in serum samples by a commercial immunoassay (EIA) and all positive samples were studied further for the presence of anti-HEV IgM antibodies (HEV IgM 3.0; DiaSorin, Turín, Italy). Positive HEV IgM antibody specimens were examined for HEV RNA by polymerase chain reaction.
Results. Anti-HEV IgG were reactive in 25 (12.5%) of the 200 HIV-infected patients, in 47 out of 200 HCV infected patients (23.5%), 10 out of 25 coinfected HIV-HCV group (40%) and 24 out of 200 healthy controls (12%). According to EIA anti-HEV IgM, 11 patients could be considered as acute hepatitis E cases but in only one of them was confirmed recent HEV infection by RT-PCR.
Conclusions. The higher seroprevalence was found in HIV-HCV coinfected patients. The only patient with HEV RNA was HIV-HCV coinfected.

Rev Esp Quimioter 2015;28(6):314-316 [pdf]

/por

Rev Esp Quimioter 2015:28(1):39-46

Burden of influenza virus type B and mismatch with the flu vaccine in Spain                                 
 


JOSE Mª EIROS-BOUZA, ALBERTO PÉREZ-RUBIO              

 

Introduction. Since the 80s two lineages of type B viruses are co – circulating in the world. Antigenic differences between them are important and it leads to lack of cross-reactivity. The impact on the burden of disease due to influenza B virus, poor foresight in estimating which of the two lineages of B viruses circulate in the season, and the consequent lack of immunity in case of including the wrong strain make that the availability of the quadrivalent vaccine is very useful. The aim of this paper is to analyze the past influenza seasons in Spain to assess the burden of disease, divergence between the vaccine strain and the circulating B and viral characteristics associated with type B in each seasonal epidemic.
Material and methods. Review of all reports issued by the Influenza Surveillance System in Spain since the 2003-2004 season to 2012-2013.
Results. Over the past influenza seasons, although type A was present mostly, circulation of influenza B virus in each season was observed, even being co – dominant in some of them. In a high number of seasons the divergence between the vaccine strain and the circulating strain lineage has been observed
Conclusions. The protective effect of influenza vaccine has varied depending on the type / subtype of influenza virus studied. The vaccine effectiveness against influenza infection by influenza B virus has varied greatly depending on the season analyzed.

Rev Esp Quimioter 2015:28(1):39-46 [pdf]

/por

Rev Esp Quimioter 2015:28(4):193-199

Safety of influenza vaccines in risk groups: analysis of adverse events following immunization reported in Valencian Community from 2005 to 2011                                 
 

ANA MARÍA ALGUACIL-RAMOS, TERESA Mª GARRIGUES-PELUFO, JULIO MUELAS-TIRADO, ANTONIO PORTERO-ALONSO, JORDI PEREZ-PANADÉS, JAIME FONS-MARTÍNEZ              

Objective. To evaluate reports of adverse events following influenza immunization by sex, risk and age groups in Valencian Community from 2005 to 2011.
Methods. A pharmacoepidemiological descriptive cross-sectional observational study based on the reports of adverse events following immunization (AEFI) against influenza, registered through the Vaccination Information System (SIV) of Valencian Community from 1 January 2005 until 31 December 2011 was done.
Results. During the study period 5,107,790 doses of vaccine against influenza were reported, with an AEFI incidence of 1.94 per 100,000 (95% CI 1.59 to 2.36), and 228,094 doses of vaccine for influenza A (H1N1) pdm09 (96.45 per 100,000, 95%CI 84.52-110.06). The 70.71% (70) and 64.55% (142), respectively, of AEFI were in women. The healthcare workers group had a higher reporting rate for seasonal influenza (25.35 per 100,000; 95%CI: 17.65-36.40) and for influenza A(H1N1) pdm09 (864.13 per 100,000; 95%CI 714.38-1044.93) during the study period.
Conclusions. Vaccines against influenza administered during the study had a high safety profile in both populations with disease risk and other susceptible target groups of vaccination. Adverse reactions reported during the study mostly coincide with those described in the summary of product characteristics of vaccines.

Rev Esp Quimioter 2015:28(4):193-199 [pdf]

/por

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]

/por

Rev Esp Quimioter 2015:28(6):317-321

Measurement of antimicrobial consumption using DDD per 100 bed-days versus DDD per 100 discharges after the implementation of an antimicrobial stewardship program     

                        
ROBERTO COLLADO, JUAN EMILIO LOSA, ELENA ALBA, ÁLVARO PIEDAD TORO, LEONOR MORENO, MONTSERRAT PÉREZ              

Introduction.  Monitoring antimicrobial consumption in hospitals is a necessary measure. The indicators commonly employed do not clearly reflect the antibiotic selection pressure. The objective of this study is to evaluate two different methods that analyze antimicrobial consumption based on DDD, per stay and per discharge, before and after the implementation an antimicrobial stewardship program.
Material and methods. Comparative pre-post study of antimicrobial consumption  with the implementation of an antimicrobial stewardship program using DDD per 100 bed-days and DDD per 100 discharges as indicators.
Results. Hospital bed days remained stable and discharges increased slightly along the period of study Antibiotic consumption in DDD per 100 bed-days decreased by 2.5% versus 3.8% when expressed as DDD per 100 discharges. Antifungal consumption decreased by more than 50%.
Conclusions. When average hospital stay decreases, reductions in the consumption of antimicrobials with an antimicrobial stewardship program system occur at the expense of reducing the number of patients receiving treatment, while increases occur due to longer durations of treatment.

Rev Esp Quimioter 2015;28(6):317-321 [pdf]

/por

Rev Esp Quimioter 2015:28(1):47-53

A practice-based observational study identifying factors associated with the use of high-dose tigecycline in the treatment of secondary peritonitis in severely ill patients                                 
 


EMILIO MASEDA, ALEJANDRO SUÁREZ-DE-LA-RICA, VÍCTOR ANILLO, PATRICIA SALGADO,
EDUARDO TAMAYO, CARLOS A. GARCÍA-BERNEDO, FERNANDO RAMASCO, MARÍA-JOSÉ VILLAGRÁN, ARACELI LÓPEZ-TOFIÑO, MARÍA-JOSÉ GIMÉNEZ, JUAN-JOSÉ GRANIZO, CARMEN HERNÁNDEZ-GANCEDO, LORENZO AGUILAR, FERNANDO GILSANZ              

 

Introduction. Based on tigecycline linear pharmacokinetic/pharmacodynamics, dose increases have been advocated to maximise activity especially when severe infections with high bacterial load and/or multidrug resistance are suspected. This practice-based observational study explored factors associated with tigecycline administration (100 mg/12h, 200 mg loading dose) in severely ill patients with complicated intra-abdominal infection (cIAI) admitted to four Surgical Critical Care Units (SCCUs).
Methods. Medical records of all consecutive adult patients with cIAI and controlled infection source requiring surgery and admission for ≥48h to SCCU were reviewed and divided into patients treated with a regimen including tigecycline (tigecycline group) and those that not (control group). A logistic regression model was performed using “tigecycline administration” (dependent variable) and variables showing differences (p≤0.1) in bivariate analyses (independent variables).
Results. One hundred and twenty one patients were included. In the tigecycline group, higher percentage of patients(vs. controls) presented colon as surgical site (66.7% vs. 41.8%, p=0.006), nosocomial infection (55.6% vs. 26.9%, p=0.001), mechanical ventilation (48.1% vs. 28.4%, p=0.025), chronic renal replacement therapy (40.7% vs. 19.4%, p=0.008), septic shock (72.2% vs. 46.3%, p=0.004), and higher values of SAPS II (48.0±15.0 vs. 39.6±15.5, p=0.003), SOFA at admission (7.0±3.3 vs. 5.5±3.7, p=0.020), lactate-24h (2.5±2.8 vs. 1.6±0.9, p=0.029) and CRP-72h (207.4±87.9 vs. 163.7±76.8, p=0.021). In the multivariate analysis (R2=0.187, p<0.001) nosocomial infection (OR=7.721; 95%CI=2.193, 27.179; p=0.001), colon as infection site (OR=4.338; 95%CI=1.432, 13.145; p=0.009) and CRP-72h (OR=1.009 per-unit; 95%CI=1.002, 1.016; p=0.012) were associated with tigecycline administration.
Conclusions. In severely ill patients with cIAI, high-dose tigecycline administration was associated with nosocomial origin of cIAI and colon as source infection site.

Rev Esp Quimioter 2015:28(1):47-53 [pdf]

/por