Rev Esp Quimioter 2016;29(1):15-24

Bacteraemia and infection of the vascular catheter in the haematology patient: positioning and management based on the Delphi method     

                        

JOSE RAMÓN AZANZA-PEREA, JAVIER LÓPEZ-JIMÉNEZ, ROCÍO PARODY-PORRAS, MIGUEL SALAVERT-LLETÍ, CARLOS SOLANO, DAVID VALCÁRCEL, CARLOS VALLEJO-LLAMAS, LOURDES VÁZQUEZ-LÓPEZ,  PABLO RIVAS-GONZÁLEZ               

Introduction. Infectious complications are an important cause of morbidity and mortality in haematological patients with febrile neutropenia. The aim of this study was to develop a consensus document of recommendations to optimize the management of febrile neutropenic patients with haematological or vascular catheter infections in areas where there is no solid scientific evidence.
Materials and Methods. After reviewing the scientific evidence, a scientific committee composed of experts in haematology and infectious diseases developed a survey with 55 statements. A two- round modified Delphi method was used to achieve consensus.
Results. The online survey was answered by 52 experts in the field of haematology and infectious diseases. After two rounds of evaluation, a consensus was possible in 43 of the 55 statements (78.2%): 40 in agreement and 3 in disagreement. Recommendations are given related to empirical antibiotic treatment of patients with febrile neutropenia, mechanisms of action, toxicity and synergism of antibiotics in this context, modifications of antibiotic treatment in the course of febrile neutropenia, and the management of central vascular catheter infections in the haematological setting.
Conclusions. There is a high degree of agreement among experts on some controversial issues concerning the management of febrile neutropenia and catheter infection in hematologic patients. This agreement has resulted in recommendations that may be useful in clinical practice.

Rev Esp Quimioter 2016;29(1):15-24 [pdf]

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Rev Esp Quimioter 2016, 29(4):195-201

Adequacy of treatment with ertapenem according to the criterion approved for the infection´s commission of a specialty hospital                     

MERCEDES MANZANO-GARCÍA, ESTHER MÁRQUEZ-SAAVEDRA             

Introduction. The inappropriate use of antibiotics in our environment increases the risk of multi-resistant bacteria, therefore it is necessary to present studies to meet and promote the proper use of antimicrobial.
Methods. Retrospective observational study in which patients who are receiving ertapenem during the period of stady (5 ½ months), were included. The adequacy of the indication to the conditions of use agreed in the Hospital was evaluated and the evolution of the treatment was monitored until the end, determining the degree of therapeutic de-escalation.
Results. 84 ertapenem prescriptions were included. The vast mayority of the prescriptions were carried out by Internal Medicine (41.7%) and the main indication was urinary tract infection (47.2%). Microbiological cultures were requested in the 75% of the patients before the first dose of ertapenem. The prescription was adapted in 69 (82.14%) of ertapenem patients to the criteria approved by the Hospital. Regarding the evolution of antibiotic therapy, treatment with ertapenem continued until resolution of the infection in 58.33% of patients. In 15 of 23 (66.21%) patients with the possibility of therapeutic de-escalation it was performed after 2-3 days of empirical treatment.
Conclusions. The vast majority of treatments ertapenem fit the criteria of prescription our Hospital. The high percentage of patients with microbiological results available, allowed in many patients the appropriate adjustment of the treatment in the first 72 hours.

Rev Esp Quimioter 2016; 29(4):195-201 [pdf]

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Rev Esp Quimioter 2016, 29(Suppl. 1):15-20

Directed therapeutic approach to Staphylococcus aureus infections. Clinical aspects of prescription                     

FRANCISCO CARMONA-TORRE, MARTA RUA, JOSÉ LUIS DEL POZO          

 

Infections caused by Staphylococcus aureus have had classically an important impact in morbidity and mortality in the nosocomial and community scene. The description of methicillin resistance among nosocomial isolates of S. aureus and his widespread diffusion has become methicillin-resistant S. aureus (MRSA) in one of the most common causes of bacterial nosocomial infections. In the last years MRSA strains have also emergence in the community. This together with a progressive increase in resistance to antibiotics used classically has become vancomycin in the treatment of choice in most cases according to clinical guidelines.
As a result, a progressive rise in the minimum inhibitory concentration (MIC) to vancomycin has been reported. In this context strains with intermediate susceptibility to vancomycin (MIC 8-4 mg/L) and heteroresistance have been noted. These strains are associated with a higher risk of treatment failure when using vancomycin.
Among isolates of S. aureus susceptible to vancomycin there has been described stains with elevated MICs (≥1.5 mg/L). It is controversial if the presence of these strains has an impact on clinical outcome if treatment with vancomycin or β-lactams is prescribed.
The development of new antibiotics with activity against MRSA and exploring synergies offer a promising alternative to treatment with vancomycin.

Rev Esp Quimioter 2016; 29(Suppl. 1):15-20 [pdf]

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Rev Esp Quimioter 2016, 29(6):332-335

Multilocus Sequence Typing analysis of human Campylobacter coli in Granada (Spain)                     

JOSÉ ANTONIO CARRILLO-ÁVILA, ANTONIO SORLÓZANO-PUERTO, MERCEDES PÉREZ-RUIZ, JOSÉ GUTIÉRREZ-FERNÁNDEZ          

Introduction. Different subtypes of Campylobacter spp. have been associated with diarrhoea and a Multilocus Sequence Typing (MLST) method has been performed for subtyping. In the present work, MLST was used to analyse the genetic diversity of eight strains of Campylobacter coli.
Material and methods. Nineteen genetic markers were amplified for MLST analysis: AnsB, DmsA, ggt, Cj1585c, CJJ81176-1367/1371, Tlp7, cj1321-cj1326, fucP, cj0178, cj0755/cfrA, ceuE, pldA, cstII, cstIII. After comparing the obtained sequences with the Campylobacter MLST database, the allele numbers, sequence types (STs) and clonal complexes (CCs) were assigned.
Results. The 8 C. coli isolates yielded 4 different STs belonging to 2 CCs. Seven isolates belong to ST-828 clonal complex and only one isolate belong to ST-21. Two samples came from the same patient, but were isolated in two different periods of time.
Conclusions. MLST can be useful for taxonomic characterization of C. coli isolates.

Rev Esp Quimioter 2016; 29(6):332-335 [pdf]

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Rev Esp Quimioter 2016, 29(2):69-75

A comparison of the efficacy of piperacillin-tazobactam and cefoperazone-sulbactam therapies in the empirical treatment of patients with febrile neutropenia     

                        

AYNUR AYNIOGLU, BIRSEN MUTLU, ABDULLAH HACIHANEFIOGLU             

  

Introduction. Empirical antibiotic therapy in neutropenic patients presenting with fever plays a significant role in reducing mortality related to infection. Empirical therapies with broad-spectrum intravenous bactericidal, anti-pseudomonal antibiotics are accepted treatments for febrile neutropenic patients. The aim of this study was to compare the efficacy of piperacillin-tazobactam (PIP-TAZO) and cefoperozone-sulbactam (CS) therapies in adult patients with haematological malignancies presenting with neutropenic fever in a prospective study design.
Methodology. Patients with haematological malignancies (leukaemia, lymphoma, multiple myeloma, and myelodysplastic syndrome) were recruited from June 2010–May 2013.  Participants were over 18 years old, with an absolute neutrophil count (ANC) of less than 500/mm³ following chemotherapy or expected to have an ANC less than 500/mm³ in the first 48 h post-chemotherapy, and with an oral body temperature ≥ 38.3°C at a single measurement or 38.0°C after 1-h monitoring. Patients were randomised to the two treatment groups. The initial empirical therapy comprised PIP-TAZO (4.5 g/6 h/day, IV) and CS (2 g/8 h/day, IV).
Results. The overall success rate was 61% with CS and 49% with PIP-TAZO (p =0.247). Factors affecting the treatment success included a neutrophil count <100/mm3, being in the relapse/refractory stage of malignancy, and the presence of a microbiologically documented infection (p <0.05).
Conclusion. PIP-TAZO and CS monotherapies are equally effective and safe for the empirical treatment of febrile neutropenic patients.

Rev Esp Quimioter 2016; 29(2):69-75 [pdf]

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Rev Esp Quimioter 2016, 29(4):220-223

Development of a PCR for the detection and quantification of parasitism by Demodex folliculorum infestation in biopsies of skin neoplasms periocular area                     

ALBERTO TENORIO-ABREU, JUAN CARLOS SÁNCHEZ-ESPAÑA, LIGIA ESPERANZA NARANJO-GONZÁLEZ, MARÍA CARMEN GONZÁLEZ-GALLEGO, CARLOS HIDALGO-GRASS, CARLOS RUÍZ-FRUTOS          

Objective. To standardize the relative quantification by mass of tissue parasitism by Demodex folliculorum infestation from neoplastic skin biopsies periocular using molecular amplification to study the possible relationship of the appearance of eyelid basal cell carcinoma with the presence and density of the mite in later works.
Methods. A quantitative PCR was developed real-time probes TaqMan. PCR was tested in a pilot 46 actual biopsy samples nodular basal cell carcinoma series.
Results. The sensitivity was placed with a detection limit of between 1 and 10 copies / μl. 50% (23/46) of the biopsies were positive for D. folliculorum. The specificity was 100% confirmed by sequencing.
Conclusion. The technique shows good results for sensitivity and specificity that can make it useful as a tool for studies of cause and effect D. folliculorum and basal cell carcinoma.

Rev Esp Quimioter 2016; 29(4):220-223 [pdf]

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Rev Esp Quimioter 2016, 29(Suppl. 1):21-25

Epidemiology of multi-drug resistant gramnegative bacilli                     

PATRICIA RUIZ-GARBAJOSA, RAFAEL CANTÓN          

Current antimicrobial resistance in Gram negative bacilli is particularly worrisome due to development of resistance to all available antimicrobial agents. This situation dramatically limits therapeutic options. The microorganisms acquire a multiresistance phenotype as a consequence of different complex processes in which the antimicrobials acts as selective driver of resistance. Dissemination of multiresistant bacteria is driven by the expansion of the high-risk clones. These clones can be selected in the presence of antimicrobials allowing their persistence over time.

Rev Esp Quimioter 2016; 29(Suppl. 1):21-25 [pdf]

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Rev Esp Quimioter 2016, 29(6):296-301

Seasonal influenza in octogenarians and nonagenarians admitted to a general hospital: epidemiology, clinical presentation and prognostic factors                     

JOSÉ M. RAMOS, M. MAR GARCÍA-NAVARRO, M. PILAR GONZÁLEZ DE LA ALEJA, ROSARIO SÁNCHEZ-MARTÍNEZ, ADELINA GIMENO-GASCÓN, SERGIO REUS, ESPERANZA MERINO, JUAN C. RODRÍGUEZ-DÍAZ JOAQUÍN PORTILLA          

Background. Seasonal influenza is responsible for high annual morbidity and mortality worldwide, especially in elderly patients. The aim of the study was to analyse the epidemiological, clinical and prognostic features of influenza in octogenarians and nonagenarians admitted to a general hospital, as well as risk factors associated with mortality.
Methods. Retrospective, cross-sectional, descriptive study in patients admitted and diagnosed with influenza by molecular biology in the General University Hospital of Alicante from 1 January to 31 April 2015.
Results. A total of 219 patients were diagnosed with influenza in the study period: 55 (25.1%) were ≤64 years-old; 77 (35.2%) were aged 65–79; 67 (30.6%) were aged 80–89 years; and 20 (9.1%) were aged ≥90 years. Most flu episodes were caused by influenza A (n=181, 82.6%). Patients aged 80 years or older had lower glomerular filtration rate (mean: 49.7 mL/min vs. 62.2 mL/min; p=0.006), a greater need for non-invasive mechanical ventilation (22% vs 9.3%; p=0.02), greater co-morbidity due to cardiac insufficiency (40.5% vs. 16.4%; p<0.001) and chronic renal disease (32.9 vs. 20%, p=0.03), and greater mortality (19% vs. 2.9%; p<0.001). In a multivariate analysis, mortality was higher in those aged 80 or over (adjusted odds ratio [ORa] 9.2, 95% confidence interval [CI] 1.65–51.1), those who had acquired the flu in a long-term care facility (ORa 11.9, 95% CI 1.06–134), and those with hyperlactataemia (ORa 1.89, 95% CI 1.20–3.00).
Conclusions. Seasonal influenza is a serious problem leading to elevated mortality in octogenarian and nonagenarian patients admitted to a general hospital.

Rev Esp Quimioter 2016; 29(6):296-301  [pdf]

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Rev Esp Quimioter 2016, 29(2):76-85

Knowledge and attitudes of healthcare workers towards a suspect case of Ebola virus disease     

                        

FRANCISCO J. GÓMEZ-ROMERO,  J. MANUEL GÓMEZ-GARCÍA, MERCEDES ARENCIBIA-JIMÉNEZ, JOSÉ ANTONIO DELGADO-DE LOS REYES, RUTH SARMIENTO-SEMPERE, ISIDRO GARCÍA-ABAD, RAMÓN VICEDO-CANO, GERARDO PÉREZ-TORREGROSA, JUAN FRANCISCO NAVARRO-GRACIA             

  

Introduction. The last outbreak of the Ebola virus disease, was a precedent to demonstrate the necessary training of healthcare personnel for possible eventualities of suspected cases of infectious diseases. It is required to study the level of qualification of healthcare workers in such situations.
Methods. Descriptive study using post-workshop survey of healthcare workers in a Valencian Community health department on acquired knowledge and skills after training.
Results and conclusions. Healthcare personnel received an overall passing score on the post-workshop survey, but with differences in occupational categories and different blocks of training. The ratings could be considered deficient in some cases. It should be reviewed periodically training health personnel and calibrate such training to the resources availa-ble for proper operation.

Rev Esp Quimioter 2016; 29(2):76-85 [pdf]

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Rev Esp Quimioter 2016, 29(4):183-189

A program for optimizing the use of antimicrobials (PROA): experience in a regional hospital                     

JON UGALDE-ESPIÑEIRA, JAIONE BILBAO-AGUIRREGOMEZCORTA, AINHOA ZURIÑE SANJUAN-LÓPEZ, CARMEN FLORISTÁN-IMÍZCOZ, LUIS ELORDUY-OTAZUA, MARGARITA VICIOLA-GARCÍA          

Introduction. Programs for optimizing the use of antibiotics (PROA) or antimicrobial stewardship programs are multidisciplinary programs developed in response to the increase of antibiotic resistant bacteria, the objective of which are to improve clinical results, to minimize adverse events and to reduce costs associated with the use of antimicrobials. The implementation of a PROA program in a 128-bed general hospital and the results obtained at 6 months are here reported.
Methods. An intervention quasi-experimental study with historical control group was designed with the objective of assessing the impact of a PROA program with a non-restrictive intervention model to help prescription, with a direct and bidirectional intervention. The basis of the program is an optimization audit of the use of antimicrobials with not imposed personalized recommendations and the use of information technologies applied to this setting. The impact on the pharmaceutical consumption and costs, cost per process, mean hospital stay, percentage of readmissions to the hospital are described.
Results. A total of 307 audits were performed. In 65.8% of cases, treatment was discontinued between the 7th and the 10th day. The main reasons of treatment discontinuation were completeness of treatment (43.6%) and lack of indication (14.7%). The reduction of pharmaceutical expenditure was 8.59% (P = 0.049) and 5.61% of the consumption in DDD/100 stays (P=0.180). The costs by processes in general surgery showed a 3.14% decrease (p=0.000).
Conclusion. The results obtained support the efficiency of these programs in small size hospitals with limited resources.

Rev Esp Quimioter 2016; 29(4):183-189 [pdf]

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