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Rev Esp Quimioter 2023; 36(5): 492-497

Analysis of the incidence and epidemiology of non-tuberculous mycobacterial infections in the health area III of Aragón

TINA HERRERO, MARIA ISABEL SANJOAQUIN, MIGUEL LAFUENTE, LUISA MARGARITA CABRERA, MARÍA BETRÁN, ANA MARIA CAMÓN

Published: 17 July 2023

http://www.doi.org/10.37201/req/019.2023

Objectives. The main objective of our investigation was to know the incidence and epidemiology of non-tuberculous mycobacteria (NTM) in our area and the prevalence of comorbidities in patients with MNT infection. As secondary objectives, we studied the distribution by species of MNT, the forms of disease and the type of sample used for its diagnosis.
Material and methods. A retrospective study was carried out in which all the isolates of mycobacteria carried out by the microbiology laboratory of the Hospital Clínico Universitario Lozano Blesa of Zaragoza during the period between January 1, 2011 and December 31, 2018 were included.
Results. A total of 533 mycobacteria were isolated, of which 295 (55.35%) were tuberculosis (MTB) and 238 (44.65%) were MNT. Of the whole MNT isolates, only 15.54% were considered clinically significant. Twenty-one species were identified being the most frequent: M. gordonae (26.89%), M. fortuitum (19.75%) and M. avium (16.39%). 32.72% of the MNT isolates were found in people over 70 years of age.
Conclusions. We can confirm that the reported number of MNT isolates in our area is higher than in previous periods. MNT infection is more common in men and those older than 70 years. The epidemiology, especially the risk factors, of MNT
disease is changing

Rev Esp Quimioter 2023; 36(5): 492-497 [Texto completo PDF]


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Rev Esp Quimioter 2023; 36(5): 486-491

Antimicrobial stewardship program in urinary tract infections due to multiresistant strains in the emergency department

JESUS RUIZ-RAMOS, SERGIO HERRERA-MATEO, MARÍA ALBA RIVERA-MARTÍNEZ, ÁLVARO ELOY MONJE-LÓPEZ, HÉCTOR HERNÁNDEZ-ONTIVEROS, CELSO SOARES PEREIA-BATISTA, YOLEIDYS MILAGROS MARTINEZ-YSASIS, MIREIA PUIG-CAMPMANY

Published: 17 July 2023

http://www.doi.org/10.37201/req/009.2023

Introduction. Urinary tract infections (UTI) are a frequent reason for attendance at emergency department (ED). The present study evaluates the impact of a multidisciplinary program for the optimization of antibiotic therapy in patients with UTI caused by multi-drug resistant bacteria treated from the hospital ED.
Material and methods. Descriptive study of the implementation of a program in which emergency, microbiology and pharmacy departments participated. Antibiotic treatment of the patients who consulted the ED with positive urine cultures caused by multidrug-resistant bacteria was reviewed upon discharge. In those patients with inappropriate treatment, doctors and/or pharmacists of the next level of healthcare or patients in the case of home discharge were contacted. The impact of the program was evaluated based on new visits to the ED at 30 days after discharge, compared with the results obtained from the usual practice three months prior the intervention.
Results. During the first year, 2,474 urine cultures of patients with UTI were reviewed, 533 (21.7%) were caused by multidrug-resistant bacteria. Empirical treatment was inappropriate in 287 (53.4%), making treatment modifications in 243 of them. 73 (19.3%) patients returned to the ED 30 days after discharge, being lower than the results obtained in the three months prior intervention (27.9%; p=0.031), without significant differences in new visits associated with UTI.
Conclusion. The implementation of a multidisciplinary program focused on multidrug resistant UTI at discharge form ED correct antibiotic therapy in a large number of patients, being a potentially tool to reduce the number of new ED visits.

Rev Esp Quimioter 2023; 36(5): 486-491 [Texto completo PDF]


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Rev Esp Quimioter 2017; 30(6):407-412

Cefditoren: a reality for the treatment of community infections

BEATRIZ SÁNCHEZ ARTOLA, JOSÉ BARBERÁN

Cefditoren, a third-generation cephalosporin, is the oral β-lactam more active against the main community-acquired respiratory tract pathogens (including resistance phenotypes such as penicillin-resistant Streptococcus pneumoniae and ampicillin-resistant Haemophilus influenzae), similar to cefotaxime. Data obtained from clinical trials and later evidence on efficacy and safety, support that cefditoren is an suitable option for the treatment of mild-to moderate community respiratory and urinary tract infections, particularly in regions where non-susceptible phenotipes to common oral antibiotics are prevalent.

Rev Esp Quimioter 2017; 30(6):407-412 [Texto completo PDF]

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Rev Esp Quimioter 2017; 30(6): 468-471

Infection by the Epstein-Barr virus between the years 2006-2015 in the health area of Santiago de Compostela. Relationship with age and sex

ROCÍO TRASTOY PENA, JOSÉ JAVIER COSTA ALCALDE, JAVIER RODRÍGUEZ CALVIÑO, DANIEL NAVARRO DE LA CRUZ, GEMA BARBEITO CASTIÑEIRAS, ANTONIO AGUILERA GUIRAO

Introduction. In Spain, the age and sex to which the primary infection by EBV is produced is poorly studied. The objective of this work is to know its relation with the presence of the primary infection by EBV between the years 2006 and 2015 in our health area.
Patients and methods. From the Santiago de Compostela health area between 2006 and 2015, 578 patients with serological patterns of EBV primoinfection were selected. This patients presented serological results of IgM-VCA positive, IgG-VCA positive and EBNA negative.
Results. We found 260/578 (45%) adolescents (11- 19 years). In the number of cases by age the maximum was observed, at 2 and 16 years. Between 14-19 years, 62% (79/127) of women between 14-16 years of age, median age 15.8 years (IQ: 14.8-16.4) compared to 48% (49/102) of men, median age 16 years (IQ: 15.7-16.6) (p = 0.032, p = 0.02, respectively).
Conclusions. As in our study, in the developed countries the majority of primary infections by EBV occur in adolescence and a bimodal distribution is observed in relation to age. During adolescence women acquire before men the first infection by EBV.

Rev Esp Quimioter 2017; 30(6): 468-471 [Texto completo PDF]

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Rev Esp Quimioter 2017; 30(6): 464-467

Performance of the KAtex test in screening and diagnosis for visceral leishmaniasis in a reference hospital

CONCEPCIÓN FERNÁNDEZ-ROLDÁN, JAVIER RODRÍGUEZ-GRANGÉR, ROSARIO JAVIER MARTÍNEZ, MIGUEL ÁNGEL LÓPEZ-RUZ, JOSÉ MARÍA NAVARRO-MARÍ, JOSÉ GUTIÉRREZ-FERNÁNDEZ

Introduction. Performing of diagnostic test simple using samples not invasive in the diagnosis of visceral leishmaniasis (VL) may be very beneficial, being necessary comparing to traditional methods.  The objective of this study was to know the reliability of test KAtex in the urine of patients with suspicion of VL.
Material and methods. Retrospectively were reviewed the medical histories of patients with suspected of VL to which are performed the test between 2009 and 2015. For its analysis were selected the patients to which is them had made study of the parasite in bone marrow.
Results. A total of 110 patients were studied, and bone marrow biopsy for research of Leishmania was performed in 44 (40%). In these patients the sensitivity of the test was 50%, the specificity of 96.7%, positive predictive value of 87.5% and negative predictive value of 80.5%.
Conclusions. KAtex antigenuria sensitivity is too low recommending it as a unique method in the detection of VL in our medium.

Rev Esp Quimioter 2017; 30(6): 464-467 [Texto completo PDF]

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Rev Esp Quimioter 2017; 30(6): 458-463

Epidemiology of the carbapenemase-producing Enterobacteriaceae spread in a community acute hospital and a non-acute rehabilitation hospital in Madrid

MARCOS LÓPEZ-DOSIL, CORNELIA BISCHOFBERGE, DAVID SÁEZ, LUISA GARCÍA-PICAZO

Introduction. In Spain, the overall prevalence of carbapenem-resistant Enterobacteriaceae (CRE) is increasing. We describe the epidemiological, clinical and microbiological characteristics features of patients with colonization or infection due to CRE in two hospitals in the north-west of Madrid during two years. One hospital was a community acute hospital and the second one was a non-acute rehabilitation hospital
Material and methods. A total of 197 CPE isolates were detected during 2013-2014.  Microbiological, epidemiological and clinical data were collected, since the first isolate was found in March 2013.
Results. A 33.5% of patients with CRE had symptomatic infection and the remaining 66.5% were colonizations. Klebsiella pneumoniae (87.8%) was the most prevalent species and OXA-48 the most frequent carbapenemase (91.9%). We found intra-interhospital spread and some differences in the epidemiology of CRE depending on the hospital, such as more genetic variability in the non-acute rehabilitation hospital.
Conclusions. Studying the CRE transmission we founded an increased incidence in a short period of time and a rapid dissemination of strains between both hospitals. This highlights the need to standardize screening measures for potential carriers and infection control programs in our hospitals.

Rev Esp Quimioter 2017; 30(6): 458-463 [Texto completo PDF]

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Rev Esp Quimioter 2017; 30(6): 443-449

Simulation of an outbreak of Acinetobacter baumannii in hospitals

ÁNGEL MARTÍN-DEL REY, MARÍA GARCÍA-MORO, ENRIQUE GARCÍA-SÁNCHEZ, ENRIQUE GARCÍA-MERINO, JOSÉ ELÍAS GARCÍA-SÁNCHEZ

Introduction. Acinetobacter baumannii infections have increased over time becoming a significant issue. Consequently, those applications that allow to predict the evolution of an outbreak and the relevance of the different control methods, are very important. The design of mathematical models plays a central role in this topic.
Material and methods. Development of a deterministic mathematical model based on ordinary differential equations whose variables and parameters are defined upon the basis of knowledge of the epidemiology and characteristics of A. baumannii. This model is analyzed from a qualitative point of view and, also, its computational implementation is derived.
Results. Several simulations were obtained developed from different initial conditions. The qualitative analysis of these simulations provides formal evidence of most effective control measures.
Conclusions. The implementation of the computational model is an extremely useful tool in terms of managing A. baumannii outbreaks. There is mathematical proof of the fact that the observance of efficient hygiene and screening rules reduces the number of infected patients.

Rev Esp Quimioter 2017; 30(6): 443-449 [Texto completo PDF]

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Rev Esp Quimioter 2017; 30(6): 413-421

Antifungal treatment with echinocandins : a 10-year clinical experience

RODRIGO POVES-ALVAREZ, BEATRIZ CANO-HERNÁNDEZ, SARA BALBÁS-ALVAREZ, PATRICIA ROMÁN-GARCÍA, MARÍA HEREDIA-RODRÍGUEZ, ESTHER GÓMEZ-SÁNCHEZ, ESTEFANÍA GÓMEZ-PESQUERA, MARIO LORENZO-LÓPEZ, BEATRIZ MARTÍNEZ-RAFAEL, MARÍA FE MUÑOZ-MORENO, JOSÉ MARÍA EIROS, EDUARDO TAMAYO

Introduction. The number of studies evaluating the use of echinocandins, whether or not its indication meets international guidelines, in clinical practice is limited. The objective of the present study was to determine the use of echinocandins in a tertiary Spanish hospital in 10 years of clinical practice, and to evaluate its impact on prognosis.
Methods. This retrospective study involved adult non-neutropenic ill patients with suspicion of fungal invasion who started treatment with echinocandins between 2006 and 2015.
Results. The number of patients treated with echinocandins was 153, and candidemia was detected thereafter in 25.5%.  Factors associated with in-hospital mortality in patients receiving echinocandins were: sex male, septic shock, Charlson comorbidity index, and total stay at the hospital. In-hospital mortality after 7, 30 and 90 days was 13.7%, 24.8%, and 56.8%, respectively. From patients receiving echinocandins, 98 did no show multifocal colonization, 50 had Candida score <2.5, and 49 did not meet Ostrosky-Zeichner prediction rule. A total of 19 patients did not show any of these 3 potential risk factors for candidemia.
Conclusions. The use of echinocandins in 10 years of clinical practice in our tertiary hospital has been performed according to international guidelines; however, candidemia was only diagnosed thereafter in only 25.5% of cases. Furthermore, according to our results, the adequate use of echinocandins seems not to be associated with reduced mortality rates. Further studies, involving a large cohort of patients and more hospitals, are required to corroborate these results.

Rev Esp Quimioter 2017; 30(6): 413-421 [Full-text PDF]

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Rev Esp Quimioter 2017; 30(6): 436-442

Febrile syndromes in the traveler returning from tropical regions admitted in a monographic unit

NATALIA MOYA NOTARIO, MICHELE HERNÁNDEZ-CABRERA, CRISTINA CARRANZA-RODRÍGUEZ, ELENA PISOS-ÁLAMO, NIEVES JAÉN-SÁNCHEZ, JOSÉ-LUIS PÉREZ-ARELLANO

Background. The aim was to analyse those syndromes with fever in travellers who return from tropical regions evaluated at our Department of Infectology and Tropical Medicine. Clarifying these conditions intends to reach earlier diagnoses and, perhaps, to avoid the emergence and spread of imported diseases, as well as to establish appropriate preventive measures.
Methods. An observational descriptive transversal study was performed, selecting those patients who returned from tropical regions with fever, amongst all travellers evaluated in our department between 1998 and 2013. We analysed demographic features, information related to the trip, as well as the presenting complaints and the diagnoses.
Results. A total of 247 international travellers presenting with fever were analysed. The most common diagnoses were self-limiting fever (29.1%), malaria (25.1%), invasive gastroenteritis (15.4%), other bacterial infections (7.4%) and genitourinary parenchymal infections (4.5%). Of all the cases, only 8.5% required hospitalization, and no case of mortality was recorded.
Conclusions. In the series presented, there are common data with other published data (malaria as a fundamental disease, difficulties in diagnosis) and different ones (less number of pre-trip consultations and admissions, higher incidence of prostatitis and fewer dengue cases).

Rev Esp Quimioter 2017; 30(6): 436-442 [Texto completo PDF]

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Rev Esp Quimioter 2017; 30(6): 429-435

Evolution of the Complexity Index of the antiretroviral therapy in HIV+ patients in a real life clinical practice

MERCEDES MANZANO-GARCÍA, AGUAS ROBUSTILLO-CORTÉS, CARMEN VICTORIA ALMEIDA-GONZÁLEZ, RAMÓN MORILLO-VERDUGO

Introduction. HIV infection has been one of the biggest successes in the healthcare world, mainly due to the appearance of antiretroviral treatment (ART). The complexity of this type of treatment has been one of the decisive factors in the follow-up of these patients.
Methods. An analytical, unicentric, retrospective observational study. We included all patients older than 18 years of age who were diagnosed with HIV who received ART in follow-up for the consultation of pharmaceutical pathology care during the year 2015. The evolution of the complexity index of ART over time and its relation with adherence to ART and concomitant treatment.
Results. A total of 619 patients were included in the study with a mean age of 47.03 ± 10.18 years. There was a reduction in CI over the years, with a significant decrease in the year 2013 and in 2015. The results obtained after the analysis of the secondary variables showed a significant relation between the adhesion to the ART and the CI of this. Patients have a lower CI (3.5) than non-adherent patients (4.25). (P = 0.003).
Conclusions. The complexity of ART is being reduced mainly by new treatment strategies and the increasing appearance of pharmaceutical coformulations. A reduction in the complexity of ART assumes a better adherence to it.

Rev Esp Quimioter 2017; 30(6): 429-435 [Texto completo PDF]

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