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]

Correlation between MALDI-TOF Vitek-MS^TM 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-MS^TM 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-MS^TM and diagnostic methods was 100% except for Yersinia enterocolitica (94.1%), Helicobacter pylori (10%) and Aeromonas veronii (0 %).
Conclusions. Vitek-MS^TM 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]

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]

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]

Uropathogen pattern and antimicrobial susceptibility in positive urinary cultures isolates from paediatric patients   

                    
VANESSA MOYA-DIONISIO, MIKEL DÍAZ-ZABALA, ALEIDA IBÁÑEZ-FERNÁNDEZ, PILAR SUÁREZ-LEIVA, VENANCIO MARTÍNEZ-SUÁREZ, FLOR ÁNGEL ORDÓÑEZ-ÁLVAREZ, FERNANDO SANTOS- RODRÍGUEZ             

Introduction. Knowledge of urophatogens and antibiotic susceptibility should be used to assist with empirical urinary tract infection treatment.
Material and methods. We retrospectively analysed local bacterial pattern and antimicrobial susceptibility in positive urinary isolates from paediatric patients collected in the period 2009-2013. Results were compared with a previous study carried out in the same sanitary area between 1995 and 1999.
Results. We identified 2,762 urinary isolates. Escherichia coli was the most common uropathogen (58.9%), followed by Enterococcus sp. (11.6%) and Proteus mirabilis (10.9%). More than 95% of non extended-spectrum beta-lactamase (ESBL)-producing E. coli were susceptible to nitrofurantoin, fosfomycin, cefotaxime and aminoglycosides. However, 56%, 49%, and 22% of the E. coli isolates were resistant to ampicillin, oral first-generation cephalosporins, and trimethoprim-sulfamethoxazole, respectively. Ampicillin and amoxicillin-clavulanate were the most effective antibiotics to treat Enterococcus sp. and P. mirabilis, respectively. Not significant modifications were found compared to results published at the same area in the ‘90s.
Conclusions.  E. coli was the mostly isolated uropathogen, with a high percentage of resistance to ampicillin, oral first-generation cephalosporins, and trimethoprim-sulfamethoxazole. These urinary isolates and antimicrobial susceptibility patterns were similar to those reported in other paediatric studies and did not show significant changes compared to local previously published results. Thus, it can be considered that the current recommendations about empiric antibiotic therapy in paediatric urinary tract infections remain applicable nowadays.

Rev Esp Quimioter 2016; 29(3):146-150 [pdf]