Rev Esp Quimioter 2016, 29(3):113-118

Bacteriobilia: a non-resolved problem  

                    
CARLOS ARMIÑANZAS, LUIS ANTONIO HERRERA, MARÍA CARMEN FARIÑAS             

Bile duct is usually sterile, and the isolating of microorganisms (bacteriobilia) has been related to some factors, such as age, biliary drainage before pancreatic surgery or bile duct stones. Gramnegative strains remain the most frequent pathogens, especially Escherichia coli. Among grampositives Enterococcus spp should be mentioned.
Currently, there is controversy about whether the presence of bacteriobilia has an impact on unfavorable outcome of biliary disease or surgical procedures or mortality rates, with complications such as surgical site infections or bacteremia.
In high-risk patients, such as immunosuppressed or those underwent pancreaticoduodenectomy, bile duct cultures performed routinely, even if there are not clinical data of infection, could be necessary in order to start antibiotic treatment or to reduce its spectrum.

Rev Esp Quimioter 2016; 29(3):113-118 [pdf]

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Rev Esp Quimioter 2016, 29(5):249-254

Demographic characteristics, malaria chemoprophylaxis and vaccination in 6,783 international travelers attended in a specialized unit                     

NIEVES JAÉN-SÁNCHEZ, LAURA SUÁREZ-HORMIGA, CRISTINA CARRANZA-RODRÍGUEZ, MICHELE HERNÁNDEZ-CABRERA, ELENA PISOS-ÁLAMO, LOURDES GARCÍA-REINA, JOSÉ LUIS  PÉREZ-ARELLANO          

Background. The objective of this paper was to determine the demographic characteristics and the evolution of international travelers treated at the Unit of Infectious and Tropical Medicine in order to improve precautions prior to travel and, thus reduce the occurrence of these diseases.
Methods.  A retrospective study of all international travelers served in UEIMT (Las Palmas de Gran Canaria) during the period 1998-2013 was performed. The following variables were collected using a standardized protocol were analyzed: age, gender, date of consultation, type of traveler, countries of destination and preventive measures undertaken (malaria chemoprophylaxis and vaccines).
Results. A total of 6,783 international travelers of which 52% were women were analyzed. The average age was 36 years (SD 13). The most frequent destination continent was Africa (39%) followed by Asia (36%) and Latin America (23%). The most common country of destination was India 13% (882), followed by Senegal 7.5% (509) and Thailand 6.3% (429). The most frequently recommended vaccines were typhoid fever (82.9%) and hepatitis A (66.9%). As for malaria prophylaxis, the indicated drugs were atovaquone-proguanil (56.5%), mefloquine (36.7%), in regard to travelers returning to visit relatives and friends with a 26.81% were children (0-9 years).
Conclusions. The overall profile of the traveler is a young man who chooses holiday destination Africa followed by Asia and Latin America. Over 50% of travelers received vaccination against typhoid and hepatitis A. The most commonly used malaria chemoprophylaxis was atovaquone / proguanil followed by mefloquine.

Rev Esp Quimioter 2016; 29(5):249-254 [pdf]

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Rev Esp Quimioter 2016, 29(Suppl. 1):47-51

The role of antimicrobial stewardship programs in the control of bacterial resistance                     

JUAN PASQUAU, SVETLANA SADYRBAEVA, SAMANTHA E. DE JESÚS, CARMEN HIDALGO-TENORIO          

In order to improve infection prognosis and reduce the existing microbial resistance problem (a challenge similar to that of climate change), a higher implication of the Administration, an increased level of social awareness and the development of specific corporate networks, including the pharmaceutical industry, is needed. However, we must first consolidate Antimicrobial Stewardship Programmes with experts who seek to improve antibiotic therapy effectivity in severe infections and to reduce global antibiotic exposure.

Rev Esp Quimioter 2016; 29(Suppl. 1):47-51 [pdf]

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Rev Esp Quimioter 2016, 29(3):123-129

Role of bacteriobilia in postoperative complications  

                    
CARLOS ARMIÑANZAS, TERESA TIGERA, DIEGO FERRER, JORGE CALVO, LUIS ANTONIO HERRERA, MARCOS PAJARÓN, MANUEL GÓMEZ-FLEITAS, MARÍA CARMEN FARIÑAS             

Introduction. At present there is a controversy regarding the impact of positive bile cultures on morbidity and mortality rates, and on the incidence of readmissions in patients with biliar disease. The aim of this study was to evaluate the role of bacteriobilia in postoperatory infections, mortality or readmissions in these patients.
Methods. The information was obtained from all patients with bile cultures admitted to Hospital Universitario Marqués de Valdecilla (Santander, Spain) from January to December 2011. Clinical, epidemiological and microbiological data and laboratory findings were analyzed. The patients were followed for two years.
Results. One hundred and fifty-two patients (65% men) were included. Mean age was 67 years (SD= 15 years). The most frequent diagnoses were acute cholecystitis (79%) and cholangitis (8%). Laparoscopic cholecystectomy was performed in 42% of patients, open cholecystectomy in 45% and percutaneous cholecystostomy in 8%. Bacteriobilia was present in 83 patients (55%). The most frecuent microorganisms isolated were Escherichia coli (31%), Enterococcus faecium (13%) and Klebsiella pneumoniae (13%). The initial antimicrobial agent was a carbapenem in 62 patients (44%) and piperacillin-tazobactam in 28 (18%). There were 39 postoperative infections (26%), 21 readmissions (14%) and 17 patients died during admission (11%). The presence of microorganisms in bile cultures was not a statistically significant predictor of neither complications nor readmissions.
Conclusions. Intra-operative bile cultures would allow guide early appropriate antibiotic treatment use in case of infection, or empiric antimicrobial therapy, however there was no correlation between bacteriobilia and postoperative infections, length of stay, mortality or readmissions.

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Rev Esp Quimioter 2016, 29(5):269-272

Prevalence and distribution of hepatitis B virus genotype D in Galicia (northwest of Spain): influence of age, sex and origin                     

JOSÉ JAVIER COSTA, JAVIER RODRÍGUEZ, JAVIER ALBA, ISIDRO RIVADULLA, MARÍA LUISA PÉREZ-DEL-MOLINO, ANTONIO AGUILERA          

Introduction. Phylogenetically, hepatitis B virus (HBV) is classified into genotypes and subgenotypes used for epidemiological studies. The aim of this study is to know the distribution of HBV subgenotypes D in our environment.
Patients and methods. From 401 patients HBV surface antigen positive, HBV DNA-positive, partial HBV-DNA S gene was amplified, sequenced and analysed using geno2pheno (hbv) (Max-Planck Institute) on line application.
Results. We found 259 (64.6%) patients with HBV genotype D: 53 not subgenotypable, 9 (4%) D1, 61 (30%) D2, 15 (7%) D3 and 121 (59%) D4. Patients with D1 subgenotype were, on average, 23 years younger (p = 0.0001), with a higher proportion of women (p < 0.05).
Conclusions. HBV subgenotype D4 was the most prevalent in our area. Patients with D1 subgenotype came from abroad were younger than the other subgenotypes and mostly women. These results show the interest of conducting studies at HBV subgenotype level.

Rev Esp Quimioter 2016; 29(5):269-272 [pdf]

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Rev Esp Quimioter 2016, 29(Suppl. 1):52-55

Diagnostic and therapeutic approach of intra-abdominal candidiasis                     

ANA MONTERO, FERNANDO GILSANZ, EMILIO MASEDA          

Invasive fungal disease is associated to a high mortality rate on critical ill patients. In the last decades an important epidemiological shift has been described. Early diagnosis and treatment are related with a better prognosis. The key factors lie in a set of predictive scores that allow to identify patients that will benefit of early treatment, as well as using diagnosis techniques that are culture independent. New diagnosis ap-proximations are being developed with promising results: in situ hybridisation using PNA-FISH probes, MALDI-TOF MS and rapid nucleic acids detection assays. The use of echinocandin is recommended as antifungal therapy on critical ill patients with candida peritonitis.

Rev Esp Quimioter 2016; 29(Suppl. 1):52-55 [pdf]

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Rev Esp Quimioter 2016, 29(3):155-158

Clinical interest of Streptococcus bovis isolates in urine 

                    
JAVIER DE TERESA-ALGUACIL, MIGUEL GUTIÉRREZ-SOTO, JAVIER RODRÍGUEZ-GRANGER, ANTONIO OSUNA-ORTEGA, JOSÉ MARÍA NAVARRO-MARÍ, JOSÉ GUTIÉRREZ-FERNÁNDEZ             

Introduction. Streptococcus bovis includes variants related to colorectal cancer and non-urinary infections. Its role as urinary pathogen is unknown. Our objective was to assess the presence of urinary infection by S. bovis, analysing the patients and subsequent clinical course.
Material and Methods. Observational study, with longitudinal data collection, performed at our centre between all the cultures requested between February and April 2015. Clinical course of the patients and response to treatment were analysed.
Results. Two thousand five hundred and twenty urine cultures were analysed, of which 831 (33%) had a significant microbial count. S. bovis was isolated in 8 patients (0.96%). In 75% of these cases the urine culture was requested because of urinary tract infection symptoms; the remaining 25% because of fever of uncertain source; during the follow-up period no evidence of cancer or endocarditis was detected. S. gallolyticus subspecie pasteurianus was the only variant observed (100%). The clinical response to initial treatment was favourable in all cases.
Conclusions. S. bovis bacteriuria may have clinical significance, especially when S. gallolyticus subspecies pasteurianus is isolated in cases with underlying urinary tract disease.

Rev Esp Quimioter 2016; 29(3):155-158 [pdf]

 

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Rev Esp Quimioter 2016, 29(5):265-268

Correlation between MALDI-TOF Vitek-MSTM system and conventional identification methods of gastrointestinal infection causing bacteria                     

CARLOS RUIZ DE ALEGRÍA-PUIG, AMAIA AGUIRRE-QUIÑONERO, JESÚS AGÜERO-BALBÍN, Mª PIA ROIZ-MESONES, LUIS MARTÍNEZ-MARTÍNEZ          

Introduction. Rapid identification of pathogens is essential for the diagnosis of gastrointestinal infections. Matrix-assisted laser desorption/ionization time of flight (MALDI-TOF) mass spectrometry has shown to be effective and fast for the identification of microorganisms. The objective of this study was to evaluate the correlation between Vitek-MSTM and conventional methods for bacterial identification causing gastrointestinal infection.
Material and methods. A total of 329 gastrointestinal pathogens were identified using Vitek-MSTM (v2 SARAMIS MS -ID, bioMérieux, Marcy-I´Étoile, France) and routine diagnostic methods simultaneously. In cases of discrepancy 16SrRNA gene sequencing was performed.
Results. The correlation between Vitek-MSTM and diagnostic methods was 100% except for Yersinia enterocolitica (94.1%), Helicobacter pylori (10%) and Aeromonas veronii (0 %).
Conclusions. Vitek-MSTM is a quick and useful method for identification of enterophatogenic bacteria. It is necessary to improve the performance of the system for the identification of H. pylori and A. veronii.

Rev Esp Quimioter 2016; 29(5):265-268 [pdf]

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Rev Esp Quimioter 2016, 29(Suppl. 1):56-58

Invasive pulmonary aspergillosis in non-neutropenic patients                     

Mª ISABEL TEJEDA, SANTIAGO SALSO, JOSÉ BARBERÁN          

The incidence of invasive pulmonary aspergillosis (IPA) is increasing among non-neutropenic patients in recent years. The difficulty of early diagnosis in these patients involves a delay in the onset of adequate treatment and higher mortality.

Rev Esp Quimioter 2016; 29(Suppl. 1):56-58 [pdf]

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Rev Esp Quimioter 2016, 29(3):130-145

A systematic review of randomized clinical trials published in Malaria Journal between 2008 and 2013  

                    
ELENA MARTÍNEZ-ALONSO, JOSÉ MANUEL RAMOS             

Background. Randomized controlled trials (RCT) are a key component in clinical research and they provide the highest quality clinical results. The objective of this study was to describe the main characteristics of RCTs published in Malaria Journal, including research topics, study population and design, funding sources and collaboration between institutions. This may help researchers and funders define future research priorities in this field.
Methods. A retrospective analysis was performed on the RCTs published in Malaria Journal between January 1, 2008 and December 31, 2013. A key-word search by “Randomized controlled trial” or “Random*” was carried out in PubMed. RCT indexed to MEDLINE were selected for the analysis.
Results. A total of 108 published articles containing RCTs were analysed. Treatment of uncomplicated Plasmodium falciparum malaria (n=45, 41.6%), especially the efficacy and safety of antimalarial drugs, and malaria prevention (n=34, 31.5%) were the two main research topics. The majority of trials were conducted in Africa (62.2%) and Asia (27%) and received external funding (private, 42.3% and/or public, 38.6%). Paediatric population was the primary study group (n=63, 58.3%), followed by adults (n=29, 26.9%). Pregnant women (n=7) and geriatric population (n=1) remain underrepresented. Nearly 75% of trials were conducted in individual subjects and 25% in groups of subjects (cluster RCTs). A considerable collaboration between researchers and institutions is noteworthy
Conclusions. RCTs published in Malaria Journal address a wide range of research topics. Paediatric trials conducted in Africa and Asia are frequently performed, and a significant worldwide collaboration to fight against malaria has been identified.

Rev Esp Quimioter 2016; 29(3):130-145 [pdf]

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