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.

Rev Esp Quimioter 2016; 29(3):123-129 [pdf]

/por

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]

/por

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]

/por

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]

 

/por

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]

/por

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]

/por

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]

/por

Rev Esp Quimioter 2016, 29(5):273-277

Prosthetic joint infection in patients with hip fracture. Differences from infection of elective prosthesis                     

JOSÉ Mª BARBERO, EDUARDO MONTERO, ALFONSO VALLÉS, MIGUEL ÁNGEL PLASENCIA, JUAN ROMANYK, JOAQUÍN LÓPEZ          

Introduction. Most publications about prosthetic joint infections (PJI) are referred to elective prosthesis and they exclude arthroplasties due to hip fracture.
Methods. We conducted a descriptive study about prosthetic joint infections after joint fracture in Alcalá de Henares Hospital (Madrid) between 2009 and 2014 and we compared with elective prosthetic infections in the same period.
Results. There were 30 PJI after hip fracture and 14 elective PJI. The incidence of infection was 4.7% in arthroplasties due to hip fracture from 1.3% in elective prosthesis (RR 3.8, p=0.005). The PJI after fracture affected older patients (82.5 years vs 71.5, p=0.006), with greater comorbidity (5.4 vs 3.6, p=0.003), higher anesthetic risk (ASA>2 70% vs 21.4%, p=0.004) and higher incidence of dementia (50% vs 0%, p=0.02). Staphylococcus aureus was the most common causative agent in both groups, but there was higher incidence of Gram negative-cases in PJI after fracture group (43.3% vs 21.4%, p no significance) and cefazolin-resistance (63.3% vs 28.6%, p=0.03). In logistic regression analysis the treatment had less chance of success in PJI after fracture than elective PJI (33.3% vs 78.6%, OR 0.09, p=0.06).
Conclusions. The PJI after fracture are more frequent than elective PJI, affect older patients, with poor general condition, are produced by more resistant bacteria and have worst evolution than EPJI.

Rev Esp Quimioter 2016; 29(5):273-277 [pdf]

/por

Rev Esp Quimioter 2016, 29(Suppl. 1):59-65

Invasive fungal infections in children: Similarities and differences with adults                     

JOSÉ TOMÁS RAMOS, LAURA FRANCISCO, ZARIFE DAOUD          

Invasive fungal infections (IFI) are a major cause of morbidity and mortality in immunocompromised adults and children. The purpose of this review was to update the epidemiological, clinical and therapeutic options in children, and to compare them with the adult population. Although there are important differences, the epidemiology, clinical features and risk factors for IFI have many similarities. Patient at risk include neutropenic hematology children, in whom Candida spp. y Aspergillus spp. predominate; primary immunodeficiencies, particularly chronic granulomatous disease with high susceptibility for Aspergillus spp.; and extremely premature infants, in whom C. albicans y C. parapsilosis are more prevalent. Premature babies are prone to dissemination, including the cen-tral nervous system. There are peculiarities in radiology and diagnostic biomarkers in children. In pulmonary aspergillosis, clasical signs in CT are usually absent. There is scant information on PCR and beta-D-glucan in children, and more limited on the performance of galactomannan enzyme immunoassay, that does not appear to be much different in neutropenic patients. There is a delay in the development of antifungals, limiting their use in children. Most azoles require therapeutic drug monitoring in children to optimize its safety and effectiveness. Pediatric treatment recommendations are mainly extrapolated from results of clinical trials performed in adults. There is no evidence for the benefit of preemptive therapy in children. It is necessary to foster specific pediatric studies with current and new antifungals to evaluate their pharmacokinetics, safety, and effectiveness at different ages in the pediatric population.

Rev Esp Quimioter 2016; 29(Suppl. 1):59-65 [pdf]

/por

Rev Esp Quimioter 2016,29(1):32-39

Intraabdominal candidiasis in surgical ICU patients treated with anidulafungin: A multicenter retrospective study     

                        
EMILIO MASEDA, MARTA RODRÍGUEZ-MANZANEQUE, DAVID DOMINGUEZ, MATILDE GONZÁLEZ-SERRANO, LORENA MOURIZ, JULIÁN ÁLVAREZ-ESCUDERO, NAZARIO OJEDA, PURIFICACIÓN SANCHEZ-ZAMORA, JUAN-JOSÉ GRANIZO, MARÍA-JOSÉ GIMÉNEZ, ON BEHALF OF THE PERI-OPERATIVE INFECTION WORKING GROUP OF THE SPANISH SOCIETY OF ANESTHESIOLOGY AND CRITICAL CARE              

Introduction. Patients with recent intraabdominal events are at uniquely risk for intraabdominal candidiasis (IAC). Candida peritonitis is a frequent and life-threatening complication in surgically ill patients. International guidelines do not specifically address IAC. This study describes clinical features of IAC in critical patients treated with anidulafungin in Surgical ICUs (SICUs).
Material and methods. A practice-based retrospective study was performed including all adults with IAC admitted to 19 SICUs for ≥24h treated with anidulafungin. IAC was documented (Candida isolation from blood/peritoneal fluid/abscess fluid and/or histopathological confirmation) or presumptive (host factors plus clinical criteria without mycological support). Total population and the subgroup of septic shock patients were analyzed.
Results. One hundred and thirty nine patients were included, 94 (67.6%) with septic shock, 112 (86.2%) after urgent surgery. Of them, 77.7% presented peritonitis and 21.6% only intraabdominal abscesses. Among 56.8% cases with documented IAC, C. albicans (52.8%) followed by C. glabrata (27.8%) were the most frequent species. Anidulafungin was primarily used as empirical therapy (59.7%), microbiologically directed (20.9%) and anticipated therapy (15.8%). Favourable response was 79.1% (76.6% among patients with septic shock). Intra-SICU mortality was 25.9% (28.7% among patients with septic shock).
Conclusions. Among IACs managed at SICUs, peritonitis was the main presentation, with high percentage of patients presenting septic shock. C. albicans followed by C. glabrata were the main responsible species. Anidulafungin treatment was mostly empirical followed by microbiologically directed therapy, with a favourable safety profile, even among patients with septic shock.

Rev Esp Quimioter 2016;29(1):32-39 [pdf]

/por