Rev Esp Quimioter 2016, 29(Suppl. 1):6-9

Epidemiology of the infection by resistant Gram-positive microorganisms                    

EMILIA CERCENADO          

Resistance among Gram-positive microorganisms to classical and new antimicrobials is a therapeutic threat. In Spain, methicillin resistance among Staphylococcus aureus (25-30%) and coagulase-negative staphylococci (50-60%) seems to have stabilized in the last decade. Among enterococci, vancomycin resistance is less than 5%. Both linezolid and daptomycin, in general, show good activity against these microorganisms. However, the resistance rates of Staphylococcus epidermidis to linezolid (20.9%), and of Enterococcus faecium to daptomycin (10.5%) in isolates from intensive care units are a worrying.

Rev Esp Quimioter 2016; 29(Suppl. 1):6-9 [pdf]

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Rev Esp Quimioter 2016, 29(5):239-243

The clinical microbiologist before the taxonomic changes in the genus Clostridium                     

JOSÉ ELÍAS GARCÍA-SÁNCHEZ, ENRIQUE GARCÍA-SÁNCHEZ, MARÍA GARCÍA-MORO          

The various species included in the genus Clostridium are very heterogeneous, both from a phenotypic and a phylogenetic point of view. The advances in polyphasic taxonomy, particularly in phylogeny, are allowing to resolve this dysfunction reclassifying several species in other genres, although there is still work to be done. Changes in generic denominations are quite normal in taxonomy, but can turn into a problem when they affect species with strong clinical impact and that have been recognised for a long time, as in the case of some traditional Clostridium species. After knowing these changes clinical microbiologists, in whose work taxonomy is an essential tool, should evaluate what matters most, if the communication with other health professionals or the phylogeny, and think about the possibility of combining both things. This paper reviews some of the taxonomic changes that have took place in well-known Clostridium species that can be clinically interesting and evaluates, as far as possible, their significance in the scientific and medical communication.

Rev Esp Quimioter 2016; 29(5):239-243 [pdf]

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Rev Esp Quimioter 2016;29(1):8-14

Ertapenem therapy for pneumonia requiring hospital admission in elderly people     

                        

ARTURO ARTERO, ÁNGEL ATIENZA, SARA CORREA, IAN LÓPEZ, ALEJANDRA FAUS, FRANÇESC PUCHADES, MANUEL MADRAZO             

 

 

Background. Few studies examined ertapenem for the treatment of pneumonia. This study aims to compare ertapenem with other antibiotics commonly used for the treatment of pneumonia requiring hospital admission in elderly patients in daily clinical practice.
Methods. We conducted an observational, retrospective case-control study, between January 2011 and January 2014, in a university hospital. Patients ≥65 years of age admitted to the hospital with pneumonia treated with ertapenem were included as cases. A control patient treated with antibiotics other than ertapenem, matched for age and pneumonia severity index (PSI), was enrolled for each case. Hospital mortality was the primary outcome.
Results. A total of 150 patients with a mean age of 84.1 years were studied. Ninety percent of patients had pneumonia PSI grade IV-V and 82.7% had one or more comorbidities. Healthcare-associated pneumonia (HCAP) and aspiration pneumonia were significantly higher in the ertapenem group (66.7% vs. 24.0%, p < 0.001 and 73.3% vs. 54.7%, p < 0.017, respectively), whereas malignancy was most common in the control group. There was no difference in the hospital mortality rate between ertapenem and control groups (20.0% vs. 20.0%, p = 0.500), after adjusting for HCAP, aspiration pneumonia and malignancy. Transfer from hospital to hospital at home was significantly higher in the ertapenem group (25.3% vs. 9.3%, p = 0.09).
Conclusions. Ertapenem is as effective as other antibiotics commonly used for the treatment of pneumonia requiring hospital admission in elderly people. Ertapenem is associated with a higher transfer to hospital at home.

Rev Esp Quimioter 2016;29(1):8-14 [pdf]

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Rev Esp Quimioter 2016, 29(4):190-194

Microbiology, antibiotic susceptibility, and bacteraemia associated factors in acute prostatitis                     

CARLES FERRÉ, FERRÁN LLOPIS, JAVIER JACOB             

Introduction. The aim of the study was to analyze the characteristics of patients with acute prostatitis presenting to the Emergency Department, the microbiological findings, antibiotic susceptibility, and bacteraemia associated factors.
Methods. Observational and cohort study with prospective follow-up including patients with acute prostatitis presenting to the Emergency Department from January-December 2012. Data were collected for demographic variables, comorbidities, microbiological findings, antibiotic treatment and outcome.
Results. Two hundred and forty one episodes of acute prostatitis were included. Mean age was 62.9 ± 16 years, a history of prostate adenoma was reported in 54 cases (22.5%) and prior manipulation of the lower urinary tract in 40 (17%). Mean symptoms duration was 3.38 ± 4.04 days, voiding symptoms were present in 176 cases (73%) and fever in 154 (64%). Seventy patients (29%) were admitted to the hospital and 3 died. From 216 urine cultures, 128 were positive (59%) and 24 (17.6%) out of 136 blood cultures. Escherichia coli was the main pathogen (58.6% of urine cultures and 64% of blood cultures) with resistant strains to fluoroquinolones, cotrimoxazole and amoxicillin/clavulanic in 27.7%, 22.9% and 27.7% of cases respectively. In the univariate analysis, only chills were associated to bacteraemia (p=0.013). At 30-day follow-up, patients with bacteraemia returned more frequently to the Emergency Department (p=0.037) and were more often admitted to the hospital (p=0.003).
Conclusions. Patients with acute prostatitis discharged from the Emergency Department need clinical follow-up and monitoring of microbiological findings in order to assure an adequate antibiotic treatment. Return to Emergency Department and admission to the hospital were significantly more frequent among patients with bacteraemia.

Rev Esp Quimioter 2016; 29(4):190-194 [pdf]

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Rev Esp Quimioter 2016, 29(Suppl. 1):10-14

Empirical therapeutic approach to infection by resistant gram positive (acute bacterial skin and skin structure infections and health care pneumonia). Value of risk factors                     

JUAN GONZÁLEZ-DELCASTILLO, MARÍA JOSÉ NÚÑEZ-ORANTOS, FRANCISCO JAVIER CANDEL, FRANCISCO JAVIER MARTÍN-SÁNCHEZ          


Antibiotic treatment inadequacy is common in these sites of infection and may have implications for the patient’s prognosis. In acute bacterial skin and skin structure infections, the document states that for the establishment of an adequate treatment it must be assessed the severity, the patient comorbidity and the risk factors for multidrug-resistant microorganism. The concept of health care-associated pneumonia is discussed and leads to errors in the etiologic diagnosis and therefore in the selection of antibiotic treatment. This paper discusses how to perform this approach to the possible etiology to guide empirical treatment.

Rev Esp Quimioter 2016; 29(Suppl. 1):10-14 [pdf]

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Rev Esp Quimioter 2016, 29(6):328-331

Evaluation of a new device for sample collection, transport and detection of Group B Streptococcus in pregnant women                     

ALBERTO TENORIO-ABREU, JOSÉ ANTONIO GÓMEZ-FERNÁNDEZ, LUIS ARROYO-PEDRERO, ESMERALDA RODRÍGUEZ-MOLINS          

We have designed a new device that combines sample collection, transportation, culture and detection of Group B Streptococcus (GBS), requiring no additional processing in the clinical laboratory. The objective was to evaluate the performance of this device for GBS detection in pregnant women. The new prototype was compared to direct plating of vaginal-rectal swabs onto Granada solid media plates. Direct plating method detected 124 positive samples out of 600 (20.6%) whereas the new device detected 10 additional positive samples (134/600, 22.3%). This new device (patent-protected) could be considered for routine GBS screening.

Rev Esp Quimioter 2016; 29(6):328-331 [pdf]

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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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