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]

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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]

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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.

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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.

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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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