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]

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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]

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Rev Esp Quimioter 2016, 29(3):146-150

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]

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Rev Esp Quimioter 2016, 29(4):230-238

2016 Expert consensus document on prevention, diagnosis and treatment of short-term peripheral venous catheter-related infections in adult                     

JOSEP A. CAPDEVILA, MARÍA GUEMBE, JOSÉ BARBERÁN, ARÍSTIDES DE ALARCÓN, EMILIO BOUZA, M. CARMEN FARIÑAS, JUAN GÁLVEZ, MIGUEL ÁNGEL GOENAGA, FRANCISCO GUTIÉRREZ, MARTHA KESTLER, PEDRO LLINARES, JOSÉ M. MIRÓ, MIGUEL MONTEJO, PATRICIA MUÑOZ, MARTA RODRÍGUEZ-CREIXEMS, DOLORES SOUSA, JOSÉ CUENCA, CARLOS-A. MESTRES ON BEHALF THE SEICAV, SEMI, SEQ AND SECTCV SOCIETIES          

The use of endovascular catheters is a routine practice in secondary and tertiary care level hospitals. Short peripheral catheters have been found to be associated with the risk of nosocomial bacteremia resulting in morbidity and mortality. Staphyloccus aureus is mostly associated with peripheral catheter insertion. This Consensus Document has been elaborated by a panel of experts of the Spanish Society of Cardiovascular Infections in cooperation with experts from the Spanish Society of Internal Medicine, Spanish Society of Chemotherapy and Spanish Society of Thoracic-Cardiovascular Surgery and aims at define and establish the norm for management of short duration peripheral vascular catheters. The document addresses the indications for insertion, catheter maintenance and registry, diagnosis and treatment of infection, indications for removal and stresses on continuous education as a driver for quality. Implementation of this norm will allow uniformity in usage thus minimizing the risk of infection and its complications.

Rev Esp Quimioter 2016; 29(4):230-238 [pdf]

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Rev Esp Quimioter 2016, 29(Suppl. 1):66-71

Current management of imported severe malaria                     

EMMANUELE VENANZI, ROGELIO LÓPEZ-VÉLEZ          

Severe malaria is a diagnostic and therapeutic emergency with great impact worldwide for incidence and mortality. The clinical presentation of severe malaria can be very polymorphic and rapidly progressing. Therefore a correct diagnosis and an early and adequate antiparasitic and support therapy are essential. This paper attempts to outline the diagnosis frame and the treatment of severe malaria for adults, paediatric patients and for pregnant.

Rev Esp Quimioter 2016; 29(Suppl. 1):66-71 [pdf]

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Rev Esp Quimioter 2016;29(1):1-7

Current status of drug treatment against the disease caused by the Ebola virus     

                        
JORDI REINA              

The recent epidemic of disease caused by the Ebola virus has highlighted the need to develop specific drugs and have to deal with this entity. According to virological analysis they have been designed to give you some new drugs and are proven to others might be effective against this virus.
The main lines of therapy are based on immunotherapy (convalescent serum of patients and specific monoclonal an-tibodies), antiviral drugs (favipiravir, BCX4430, brincidofovir), interfering RNAs (TKM-Ebola) and antisense oligonucleotides (morpholino phosphorodiamidate) and other drugs no antiviral (clomiphene NSC62914, FGI-103, amiloride and ouabain).
Existing studies are scarce and mainly in animal models and clinical trials have been inconclusive most by the drastic reduction in the number of new cases.
However, progress has been made in the biological knowl-edge of Ebola virus and have been located new therapeutic tar-gets for the future development of specific antiviral.

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Rev Esp Quimioter 2016, 29(3):119-122

An antimicrobial stewardship program reduces antimicrobial therapy duration and hospital stay in surgical wards   

                    
ROBERT GÜERRI-FERNÁNDEZ, JUDIT VILLAR-GARCÍA, SABINA HERRERA-FERNÁNDEZ, MARTA TRENCHS-RODRÍGUEZ, JORDI FERNÁNDEZ-MORATO, LUCÍA MORO, JOAN SANCHO, LUIS GRANDE, ALBERT CLARÁ, SANTIAGO GRAU, JUAN PABLO HORCAJADA             

An antimicrobial stewardship program reduces antimicrobial therapy duration and hospital stay in surgical wardsWe report a quasi-experimental study of the implementation of an antimicrobial stewardship program in two surgical wards, with a pre-intervention period with just assessment of prescription and an intervention period with a prospective audit on antibiotic prescription model. There was a significant reduction of length of stay and the total days of antimicrobial administration. There were no differences in mortality between groups. The antimicrobial stewardship program led to the early detection of inappropriate empirical antibiotic treatment and was associated with a significant reduction in length of stay and the total duration of antimicrobial therapy.

Rev Esp Quimioter 2016; 29(3):119-122 [pdf]

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Rev Esp Quimioter 2016, 29(5):244-248

About microbiological methods for detection of oxacillin resistance in coagulase-negative staphylococci                     

MIGUEL FAJARDO, ROCÍO HIDALGO, JORGE GAITÁN, ROSA SÁNCHEZ-SILOS, PALOMA MARTÍN-CORDERO          

Introduction. Coagulase-negative staphylococci (CoNS) take part of the human skin and mucous membranes, but they are also involving in infections with the increasing use of prosthetic, indwelling devices or intravascular catheter-related bacteraemia. They are more resistance than Staphylococcus aureus against a wide range of antimicrobial agents, and it have been observed an increase in morbidity and mortality of patients with incorrect treatment.
Material and methods. To analyze the results obtained by different commercial techniques: two automatic microdilution systems (MicroScan and Vitek2 Compact), PBP2a agglutiation test, with and without 1 μg oxacillin disk induction, and detection of mecA gene by nucleic acids amplification techniques, for the diagnosis of methicillin resistance staphylococci in 170 strains of CoNS isolated from blood cultures.
Results. One hundred and seventy methicillin resistance staphylococci were detected by MicroScan, 167 strains by Vitek 2 Compact, 115 strains were PBP2a positive without oxacillin induction and 168 after oxacillin induction. Finally, 167 strains were mecA gene positive detected by nucleic acids amplification techniques.
Conclusions. It is necessary to do oxacillin induction before PBP2a test to avoid false negatives. There are a great variability in the phenotypic expression of methicillin resistance in CoNS.

Rev Esp Quimioter 2016; 29(5):244-248 [pdf]

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Rev Esp Quimioter 2016, 29(Suppl. 1):72-75

Resistance to the antimalarial drugs                     

EMMANUELE VENANZI, ROGELIO LÓPEZ-VÉLEZ          

Malaria is one of the most widespread infectious diseases around the world with 214 million cases and 438,000 deaths in 2015. In the early twentieth century it was described for the first time the resistance to quinine and, since then, drug resistance to antimalarial drugs has spread up to represent a global challenge in the fight and control of malaria. Understanding the mechanisms, geography and monitoring tools that we can act against resistance to antimalarial drugs is critical to prevent its expansion.

Rev Esp Quimioter 2016; 29(Suppl. 1):72-75 [pdf]

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Rev Esp Quimioter 2016;29(1):25-31

Dual therapy as an alternative treatment in HIV pretreatred patients: experience in a tertiary hospital     

                        
 LUCIA YUNQUERA-ROMERO, ROCÍO ASENSI-DÍEZ, MACARENA GAJARDO-ÁLVAREZ, ISABEL MUÑOZ-CASTILLO              

Introduction. Dual therapy regimen might be an effective alternative to prevent the occurrence of side effects and comorbidities associated with prolonged treatment with antiretroviral (ARV) and a way of simplification of antiretroviral therapy (ART) to improve adherence in certain patients. It also represents a potential treatment option for patients who have failed previous TAR.
Methods. The aim of the study is to describe the effectiveness, adherence and costs of dual therapy regimen used in pretreated HIV patients in tertiary hospital.
Results. Thirty-eight patients were studied (eight were excluded). Reasons for simplification to dual therapy were previous treatment toxicity (40%), simplification (36.67%) and virological rescue (20%). The dual therapy regimens most used were: IP/r + INSTIs (26.67%), IP/r + NRTIs (23.33%), IP/r + NNR-TIs (23.33%), IP/r+ CCR5 (16.66%) e INSTIs + NNRTIs (10%). ARV more used were darunavir/ritonavir (DRV/r) + raltegravir (23.33 %); DRV/r + lamivudine (20%) y DRV/r + etravirine (16.67 %). Adherence was 86.79% before switching to dual therapy and 96.27% after switching. The cost savings of switching to dual therapy of these patients was € 3,635.16.
Discussion. Dual therapy with IP/r might be an effective alternative to selected treatment experienced patients compared with conventional therapy.

Rev Esp Quimioter 2016;29(1):25-31 [pdf]

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