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(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]

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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.

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Rev Esp Quimioter 2015:28(4):200-206

Maraviroc modifies gut microbiota composition in a mouse model of obesity: a plausible therapeutic option to prevent metabolic disorders in HIV-infected patients                                 
 

PATRICIA PÉREZ-MATUTE, LAURA PÉREZ-MARTÍNEZ, JAVIER AGUILERA-LIZARRAGA, JOSÉ R. BLANCO, JOSE A. OTEO              

Introduction. The proportion of HIV-infected patients with overweight/obesity has increased in recent years. These patients have an increased metabolic/cardiovascular risk compared with non-obese patients. Modulation of gut microbiota composition arises as a promising tool to prevent the develop-ment of obesity and associated disorders. The aim of this study was to investigate the impacts of maraviroc (MVC), a CCR5 antagonist approved for clinical use in HIV-infected patients, on gut microbiota composition in a mouse model of obesity.
Methods. Thirty two male C57BL/6 mice were assigned to:a) Control (chow diet), b) MVC (chow diet plus 300 mg/L MVC), c) High-fat diet (HFD) or d) HFD/MVC (HFD plus 300 mg/L MVC) groups. Body weight and food intake was recorded every 2-3 days. Mice were euthanized after 16 weeks of treatment and cecal contents were removed to analyse by real-time PCR four bacterial orders from the most dominant phyla in gut.
Results. Mice fed with a HFD showed a significant increase in Enterobacteriales (p<0.001 vs. control). MVC treatment induced a significant decrease in control (p<0.05) and HFD fed mice (p<0.001). Interestingly, this order was positively associated with body weight gain, insulin resistance and fatty liver. HFD induced a significant decrease in Bacteroidales and Clostridiales levels (p<0.05 and p<0.01, respectively). MVC decreased the presence of Bacteroidales (p<0.05 vs. control) while an increase was observed in HFD/MVC mice (p=0.01 vs. HFD). No direct effects of MVC were observed on Clostridiales and Lactobacillales.
Conclusions. MVC may constitute a new therapeutic option to prevent obesity and related disorders in HIV-infected patients.

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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.

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Rev Esp Quimioter 2015:28(2):79-85

An analysis of the association between genotype and antimicrobial resistance in methicillin-resistant Staphylococcus aureus clinical isolates                                 
 


VICENTE AGUADERO, CARMEN GONZÁLEZ-VELASCO, ANA VINDEL, MIGUEL GONZÁLEZ-VELASCO, JUAN JOSÉ MORENO              

 

Genotyping methods are useful resources for the surveillance, detection, prevention and control of multidrug-resistant nosocomial agents, such as methicillin-resistant Staphylococcus aureus (MRSA). An understanding of the association between genotype and antibiotic susceptibility in MRSA clones may be useful in the surveillance of MRSA and to avoid inappropriate treatment future resistance. We genotyped MRSA clinical isolates from the Extremadura region of Spain using pulsed field electrophoresis (PFGE) and analyzed the spectrum of antibiotic susceptibility for each isolate to determine whether resistance is associated with specific genotypes. PFGE revealed six major genotypes: E8a (25%), E7b (17%), E7a (12%), E8B (8%), E10 (6%), and E20 (4%). Isolates with the genotypes E8a and E10 exhibit higher resistance ratios for levofloxacin than isolates with the other major pulsotypes. Similar results were obtained for isolates with the E20 pulsotype with respect to mupirocin. Although we identified no vancomycin-, tigecycline-, linezolid- or daptomycin-resistant strains, we observed significant differences in the mean MIC values obtained for some of these drugs among the major genotypes. Specifically, isolates with the E7b, E8b, and E20 genotypes have signif-icantly higher MICs of tigecycline, vancomycin and linezolid, respectively, than the most sensitive pulsotypes. Isolates with the E8b profile also exhibit a significantly higher rate of re-duced vancomycin susceptibility (RVS) (i.e., MIC between 1 and 2 mg/L) than clones with the E10 and E8a profiles. In conclusion, we report associations between genotype and antibiotic sensitivity that should be considered in programs for monitor-ing and controlling MRSA in health care settings.

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Rev Esp Quimioter 2015:28(4):207-209

Characterization of daptomycin non-susceptible Enterococcus faecium producing urinary tract infection in a renal transplant recipient      

                          

ANTONIO SORLÓZANO, DIANA PANESSO, JOSÉ MARÍA NAVARRO-MARÍ, CESAR A ARIAS, JOSÉ GUTIÉRREZ-FERNÁNDEZ              

Objectives. Characterization of a urine isolate of daptomycin non-susceptible Enterococcus faecium recovered from a patient with kidney transplantation and no history of daptomycin exposure.
Methods. After isolation in a urine sample, identification of E. faecium was confirmed by amplification of the E. faecium-specific gene encoding D-alanyl-D-alanine ligase (ddl) and daptomycin susceptibility testing was performed by E-test on cation-adjusted Mueller-Hinton agar. In order to determine the genetic bases of daptomycin resistance, the open reading frames of five genes previously associated with daptomycin resistance in enterococci were sequenced.
Results. Substitutions in the response regulator LiaR (S19F) and cardiolipin synthase (R218Q) were identified.
Conclusions. To the best of our knowledge, this is the first characterization of emerging daptomycin resistance in E. faecium in a Spanish hospital in the absence of daptomycin exposure and in a renal transplant recipient.

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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.

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Rev Esp Quimioter 2015:28(2):86-91

Detection of unusual uropathogens during a period of three years in a regional hospital                                 
 


CRISTINA GÓMEZ-CAMARASA, CARMEN LIÉBANA-MARTOS, JOSÉ MARÍA NAVARRO-MARÍ, JOSÉ GUTIÉRREZ-FERNÁNDEZ              

 

Urinary tract infections (UTIs) are one of the most fre-quent both in the community and in hospitals infectious diseases. The etiology of urinary tract infections is well established but may vary depending on various factors such as age, the presence of underlying diseases such as diabetes, instrumental procedures such as urinary catheterization or exposure to antibiotics or previous hospitalizations.  UTIs diagnosed cases were retrospectively reviewed for unusual microorganisms over a period of 3 years (2011-2013) in the Microbiology Laboratory of the Hospital Virgen de las Nieves of Granada (Spain), following the standard operating procedure, which we describe four cases caused by Trichosporon asahii, Aerococcus urinae, Pasteurella bettyae and Neisseria sicca. Hence the importance of having in the Clinical Microbiology Laboratory of the tools necessary to detection UTIs and reach a correct identification in all cases.

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Rev Esp Quimioter 2015:28(4):210-213

In vitro antifungal susceptibility profile of Scopulariopsis brevicaulis isolated from onychomycosis     

                        
ALFONSO JAVIER CARRILLO-MUÑOZ, CRISTINA TUR-TUR, DÉLIA CÁRDENES, FLORENCIA ROJAS, GUSTAVO GIUSIANO              

We studied the in vitro antifungal activity profile of amorolfine (AMR), bifonazole (BFZ), clotrimazole (CLZ), econazole (ECZ), fluconazole (FNZ), itraconazole (ITZ), ketoconazole (KTZ), miconazole (MNZ), oxiconazole (OXZ), tioconazole (TCZ) and terbinafine (TRB)  against 26 clinical isolates of Scopulariopsis brevicaulis from patients with onychomycosis by means of an standardized microdilution method. Although this opportunistic filamentous fungi was reported as resistant to several broad-spectrum antifungals agents, obtained data shows a better fungistatic in vitro activity of AMR, OXZ and TRB (0.08, 0.3, and 0.35 mg/L, respectively) in comparison to that of CLZ (0.47 mg/L), ECZ (1.48 mg/L), MNZ (1.56 mg/L, BFZ (2.8 mg/L), TCZ (3.33 mg/L), KTZ (3.73 mg/L). FNZ (178.47 mg/L) and ITZ (4.7 mg/L) showed a reduced in vitro antifungal activity against S. brevicaulis. Obtained MICs show the low in vitro antifungal susceptibility of S. brevicaulis to topical drugs for onychomycosis management, with exceptions (AMR, OZX and TRB).

Rev Esp Quimioter 2015:28(4):210-213 [pdf]

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