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]

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]

Demographic and clinical features of diagnosed individuals of enterobiasis in the southern Gran Canaria: sampling assessment                     

DEYANIRA CARRILLO-QUINTERO, LAURA DEL OTERO SANZ, SARA HERNÁNDEZ-EGIDO, ANTONIO MANUEL MARTÍN SÁNCHEZ          

Introduction. Enterobius vermicularis, also known as pinworn, is the responsible agent for Human Enterobiasis. It is one of the most prevalent, but underrated, parasitic disease in children population. Diagnosis involves demonstration of either eggs or adult worms by Graham test. The aim of this study is to describe the clinical, demographic and microbiological features of patients with suspected diagnosis of Enterobiasis in southern Gran Canaria.
Material and methods. Descriptive and prospective study of perianal samples evaluated by Graham test in the Microbiology Department of `Insular de Gran Canaria´ University Hospital between November 2014 and November 2015. Descriptive analysis to evaluate the correlation between clinical and demographic variables and the results of Graham test microbiological observation.
Results. 1,128 samples were analyzed. E. vermicularis was found in 11.4% of the samples. Among the positives samples, 88.4% belonged to children under 14 years, and 53.5% were male. Abdominal pain (18.6%), anal itching (11.6%), eosinophilia (8.5%) and intestinal parasitosis suspicion (7.8%) were the reasons of parasitological investigation request in positive samples. Nevertheless, a high proportion of the requests was not founded in a suspicious diagnosis or was unrelated to Enterobiasis.
Conclusions. Enterobiasis is a common disease in primary health care and is of great importance in Gran Canaria. Quality in sample collection as well as diagnosis suspicious information are necessary for a good microbiological analysis.

Rev Esp Quimioter 2016; 29(6):302-307  [pdf]

Antimicrobial susceptibility of Gram-negative bacilli of community acquired intra-abdominal infections in a hospital at Buenos Aires, Argentina                     

LAURA MORGANTI, EZEQUIEL CÓRDOVA, ELSA CASSINI, NORA GÓMEZ, LAURA LÓPEZ MORAL, MARCELA BADÍA, CLAUDIA RODRÍGUEZ          

Introduction. Community acquired complicated intra-abdominal infections (cIAI) are a common condition. Few data are available about the level of antimicrobial resistance of Gram-negative bacteria isolated from community acquired cIAIs in Argentina.
Methods. Retrospective-prospective observational study (March 2010 to February 2012). Gram-negative bacteria antimicrobial susceptibility of isolates from community acquired cIAIs were evaluated.
Results. During this period, a total of 85 patients were included and 138 pathogens were collected. Male sex: 58%. Median age: 33. Monomicrobial cultures were obtained in 49% of the cases. Ninety (65%) corresponded to Gram-negative organisms, and 48 (38%) to Gram-positive cocci. Gram-negative organisms most frequently observed were: Escherichia coli 76%, Klebsiella pneumoniae 8%, Pseudomonas aeruginosa 7% and Enterobacter spp. 6%. E. coli and K. pneumoniae showed a high percentage of strains resistance to ciprofloxacin of 37% and 29%, respectively. Similarly, resistance to ampicillin/sulbactam was observed in a 16% of the E. coli isolates. The prevalence of multiresistant Gram-negative organisms was 38%.
Conclusions. A high level of resistance to antimicrobials was observed in community acquired cIAIs, mainly to ciprofloxacin and ampicillin/sulbactam two of the most used antimicrobial for empirically treatment of cIAIs in our country. In addition a significant proportion of multiresistant Gram-negative organisms were identified.

Rev Esp Quimioter 2016; 29(4):202-205 [pdf]