Rev Esp Quimioter 2017, 30(4):276-279

Outpatient parenteral antimicrobial therapy for infective endocarditis in patients over 80 years

XABIER KORTAJARENA, MIGUEL ÁNGEL GOENAGA, MAIALEN IBARGUREN, HARKAITZ AZKUNE, MARIA JESUS BUSTINDUY, ANA FUERTES, OIHANA IBARGUREN, MUSKILDA GOYENECHE, REBECA GARCIA, GAMEGI GROUP HOSPITAL UNIVERSITARIO DONOSTIA

Introduction. The incidence of infective endocarditis is progressively increasing, especially in elderly patients. Outpatient parenteral antibiotic therapy (OPAT) is being an excellent alternative for treatment, but advanced age is one of the relative contraindications. The aim of this study is to compare the characteristics and prognosis of patients less or more than 80 years, treated with OPAT.
Material and methods. One hundred and ninety four pa-tients were included between 1996 and 2015, 31 of them older than 80 years.
Results. The most frequently affected valve is the aortic one, mainly native valves. Most used antibiotics are ceftriaxone, ampicillin, cloxacillin and daptomycin. Differences in surgery (39.9% vs 9.7%, p=0.001) and use of infusion pump (55.2% vs 35.5%; p= 0.044) were observed, under 80 years and older respectively. No differences in readmissions and mortality were observed.
Conclusions. OPAT could be considered an effective alternative for appropriately-selected elderly patients with infective endocarditis.

Rev Esp Quimioter 2017; 30(4):276-279 [pdf]
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Rev Esp Quimioter 2017, 30(4):269-275

Impact of 13-valent pneumococal conjugate polysaccharide vaccination on exacerbations rate of COPD patients with moderate to severe obstruction

JUAN MARCO FIGUEIRA-GONÇALVES, NATALIA BETHENCOURT-MARTÍN, LINA INMACULADA PÉREZ-MÉNDEZ, DAVID DÍAZ-PÉREZ, CRISTINA GUZMÁN-SÁENZ, PEDRO VIÑA-MANRIQUE, ARTURO JOSÉ PEDRERO-GARCÍA

Introduction. One of the major microorganisms described as the cause of exacerbations of chronic obstructive pulmonary disease (COPD) is Streptococcus pneumoniae. The aim of this study is to evaluate the impact of 13-valent pneumococcal conjugate polysaccharide vaccine (PCV13) in COPD patients with regard to the development of exacerbations and the possible differential effect according to the patient’s phenotype.
Material and methods. Prospective observational study of patients with COPD and FEV1 ? 65% and 18-month follow-up. Main variables: vaccination status with PCV13, phenotype “exacerbator” or “non-exacerbator”, number of exacerbations, hospitalization and deaths. A descriptive statistical analysis was performed according to the nature of the variable and an inferential analysis with CI95%, bivariate contrasts, and multivariate analysis. Significance level 5%. The statistical packages EPIDAT 3.0 and SPSS version 21.0 were used.
Results. 121 patients were included. Twenty-four percent were labeled as phenotype exacerbator. 36% were vaccinated with PCV13. During follow-up, 68% of patients had at least one exacerbation and 27% required hospitalization. We observed similarity (p> 0.05) in the number of exacerbations and deaths; however, the percentage of hospitalization in the vaccinated was 18%, compared to 32% in the non-vaccinated group. In the multivariate adjustment (controlling for the phenotype), an adjusted OR of 2.77 risk of hospitalization was observed in the non-vaccinated group (p = 0.044).
Conclusions. Non-vaccination with PCV13 almost triples the risk of hospitalization in patients with COPD.

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Rev Esp Quimioter 2017, 30(4):264-268

Decolonization for Staphylococcus aureus carriers in arthroplasty surgery after hip fracture

OSÉ Mª BARBERO, JUAN ROMANYK, ALFONSO VALLÉS, MIGUEL ÁNGEL PLASENCIA, EDUARDO MONTERO, JOAQUÍN LÓPEZ

Introduction. Staphylococcus aureus is the main causative agent of joint prosthesis infections. The decolonization of the carriers is effective in the prevention of the infections of the elective arthroplasties. The aim of this study is to evaluate if it is also in arthroplasties after hip fracture.
Methods. Study in patients with hip fracture who underwent joint prosthesis from January 2011 to December 2015 with a protocol of S. aureus detection-decolonization with intranasal mupirocin and chlorhexidine baths. Patients between January 2009 and December 2010 were the comparison group.
Results. In the intervention period, the study of colonization of S. aureus was performed in 307 patients, of whom 87 were positive (28.3%). The study period was completed by 267 patients, of whom two developed S. aureus infection, compared to six of 138 in the control group (0.7% vs 4.3%, RR 0.1, p = 0.03).
Conclusion. In our study, S. aureus decolonization in patients with hip fracture decreased the incidence of joint prosthesis infection by this microorganism.

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Rev Esp Quimioter 2017; 30(3): 213-223

Consensus opinion on antifungal prophylaxis in haematologic patients: Results of the PROMIC project

LOURDES VÁZQUEZ LÓPEZ, TERESA VILLAESCUSA DE LA ROSA, RAFAEL DE LA CÁMARA, ILDEFONSO ESPIGADO, SANTIAGO GRAU CERRATO, MANUEL JURADO, MONTSERRAT ROVIRA, MIGUEL SALAVERT, DAVID SERRANO SIMONNEAU, CARLOS SOLANO VERCET, ISABEL RUIZ CAMPS

Introduction. Invasive fungal disease (IFD) is an important cause of morbidity and mortality in haematological patients. Antifungal prophylaxis (AFP) is indicated for a number of clinical scenarios in this group of patients. The aim of this study was to reach a consensus on IFD prophylaxis in haematological patients in order to optimize their management.
Methods. A committee of experts in haematology and infectious diseases compiled a survey of 79 items with controversial aspects about antifungal prophylaxis in haematological patients. The survey was evaluated in two rounds by a panel of experts following a modified Delphi methodology.
Results. Forty-four experts in haematology and infectious diseases answered the survey. After two evaluation rounds, consensus was reached in 67 of the 79 items (84.8%), specifically 48 items were consensually agreed on (60.7%) and 19 were disagreed on (24.0%). Consensus was reached on prophylaxis candidates profiles and questions related to indications, mechanisms of action, spectrum of activity, toxicity and interactions of antifungal were elucidated. The usefulness of micafungin in IFD prophylaxis was particularly analysed. The consensus reached was that micafungin is an antifungal to be considered in this context as its safety profile and lower interaction potential may be advantageous.
Conclusions. A broad consensus was found in the management of IFD prophylaxis in the haematological patient. This consensus provides practical indications about its optimal management and can help determine the profile of patients eligible for this type of intervention.

Rev Esp Quimioter 2017; 30(3): 213-223 [pdf]
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Rev Esp Quimioter 2017; 30(3): 207-212

Clinical presentation of candidaemia in elderly patients: experience in a single institution

ANA LERMA, ELENA CANTERO, MARÍA SORIANO, BEATRIZ ORDEN, ELENA MUÑEZ, ANTONIO RAMOS-MARTINEZ

Objective. To analyse the clinical presentation of candidaemia in elderly patients.
Methods. A comparison of clinical presentation of candidaemia cases was carried out in a Spanish tertiary hospital between January 2010 and September 2015.
Results. Forty-five cases (32%) corresponded to elderly patients (? 75 years) and 95 cases (68%) to non-elderly patients (16-74 years). A higher proportion of elderly patients presented solid tumour (51% versus 32%, p=0.026) and a lower proportion had undergone solid or hematopoietic transplantation (0% versus 28%, p<0.001). Fewer elderly patients (16 patients, 36%) had a central venous line inserted than non-elderly patients (81 patients, 85%, p<0.001). Isolation of Candida parapsilosis was significantly lower among elderly (13.3%) than among non-elderly patients (32%, p=0.015). Fundoscopy was carried out in 20 elderly (44%) and in 64 younger patients (67%, p=0.009). The proportion of patients who underwent echocardiography was similar in both groups (56% vs 66%, respectively; p=0.218). Adequate antifungal treatment within the first 48 hours was administered in16 elderly patients (36%) and 58 younger patients (61%, p=0.005). Catheter removal was carried out in 9 elderly patients (68.1%) and in 40 non-elderly patients (49%, p=0.544). Mortality was higher among elderly patients (55.6%) than non-elderly patients (36.8%; p=0.037).
Conclusions. Elderly patients account for a substantial proportion of patients suffering from candidaemia in recent years. The clinical management of these patients was less appropriate than in younger patients with respect to fundus examination and the prescription of appropriate antifungal treatment. Mortality in elderly patients was higher than in younger patients.

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Rev Esp Quimioter 2017; 30(3): 201-206

Epidemiological surveillance for multidrug-resistant microorganisms in a general ICU

ANA FERNÁNDEZ-VERDUGO, JAVIER FERNÁNDEZ, DOLORES ESCUDERO, LUIS COFIÑO, LORENA FORCELLEDO, MAURICIO TELENTI, EMILIO GARCÍA-PRIETO, RAQUEL RODRÍGUEZ-GARCÍA, LAURA ÁLVAREZ-GARCÍA, ANA PÉREZ-GARCÍA, CARLOS RODRÍGUEZ-LUCAS, FERNANDO VAZQUEZ

Introduction. Multidrug resistant (MDR) microorganisms represent a threat for patients admitted in Intensive Care Units (ICUs). The objective of the present study is to analyse the results of epidemiological surveillance cultures for these microorganisms in one of these units.
Material and methods. General ICU. Retrospective analysis, descriptive statistics. Analysis of epidemiological surveillance cultures for MDR microorganisms in 2015. Studied microorganisms: Methicillin-resistant Staphylococcus aureus (MRSA), ESBL-and/or carbapenemase-producing Klebsiella pneumoniae (CESBL-KP) and MDR Acinetobacter baumannii (MDRAB).
Results. One thousand, two hundred and fifty nine patients admitted. A total of 2,234 specimens from 384 patients were analysed (690, 634, 62 and 286 were rectal, throat, nasal and skin swabs respectively). Global APACHE II was 18.3 ± 8 versus 21.7 ± 7.8 in patients colonized/infected on admission. Global mortality was 19.7% versus 22.3% in patients colonized/infected on admission. The higher sensitivities achieved with the different samples for the different microorganism detection were as follows. MRSA: 79% and 90% for nasal and nasal + throat swabs, respectively. MDRAB: 80% and 95% for throat and throat + rectal swabs, respectively. CESBL-KP: 95% and 98% for rectal and rectal + throat swabs, respectively. 94 out of the 384 patients (24.4%) were colonized/infected with MDR at admission. 134 patients (10.6% of the total patients admitted) were colonized/infected with a total of 169 MMR during the hospital stay. MRSA has the earliest colonization/infection (9.2 ± 6.4days) and ESBL-producing Enterobacteriaceae, the latest (18.7± 16.4 days).
Conclusions. 24.4% of patients were colonized/infected by MDR at admission. Nasal, throat and rectal swabs were the most effective specimens for recovering MRSA, MDRAB and CESBL-KP, respectively. The combination of two specimens improves MDR detection except for CESBL-KP. Skin swabs are worthless. The most prevalent MDR at admission were ESBL-producing Enterobacteriaceae while the most frequent hospital acquired MDR was MDRAB.

Rev Esp Quimioter 2017; 30(3): 201-206 [pdf]
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Rev Esp Quimioter 2017; 30(3): 195-200

A rapid validated UV-HPLC method for the simultaneous determination of the antiretroviral compounds darunavir and raltegravir in their dosage form

GABRIEL ESTAN-CEREZO, ANA GARCÍA-MONSALVE, LETICIA SORIANO-IRIGARAY, FRANCISCO JOSÉ RODRÍGUEZ-LUCENA, ANDRÉS NAVARRO-RUIZ

Introduction. A rapid, simple and sensitive high-performance liquid chromatography (HPLC) method with ultraviolet detection has been developed for quantification of darunavir and raltegravir in their pharmaceutical dosage form.
Material and methods. The assay enables the measurement of both drugs with a linear calibration curve (R2= 0.999) over the concentration range 5–100 mg/L. The determination was performed on an analytical Tracer Excel 120 ODSB (15×0.4.6 cm) column at 35ºC. The selected wavelength was 254 nm. The mobile phase was a mixture of 0.037 M sodium dihydrogen phosphate buffer, acetonitrile and methanol (40:50:10, v/v/v) at a flow rate of 2.0 mL/min Nevirapine (50 mg/L) was used as internal standard.
Results. Accuracy, intra-day repeatability (n = 5), and inter-day precision (n = 3) were found to be satisfactory, being the accuracy from -4.33 to 3.88% and precisions were intra-day and inter-day, 0.25% and 4.42% respectively in case of darunavir. Raltegravir intra-day and inter-day precisions lower of 1.01 and 2.36%, respectively and accuracy values bet from -4.02 to 1.06%.
Conclusions. Determination of the darunavir and raltegravir in their dosage form was done with a maximum deviation of 4%. This analytical method is rapid, easily implantable and offers good results..

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Rev Esp Quimioter 2017; 30(3): 183-194

Carbapenem resistance in Pseudomonas aeruginosa isolated from urine cultures: prevalence and risk factors

JUDITH ÁLVAREZ-OTERO, JOSE LUIS LAMAS-FERREIRO, LUCÍA GONZÁLEZ-GONZÁLEZ, IRENE RODRÍGUEZ-CONDE, MARÍA JOSÉ FERNÁNDEZ-SONEIRA, ALEXANDRA ARCA-BLANCO, JOSE RAMÓN BERMÚDEZ-SANJURJO, JAVIER DE LA FUENTE-AGUADO

Introduction. Pseudomonas aeruginosa is a non-fermentative gram-negative bacillus with a great ability to develop resistance to multiple antibiotics, including carbapenems, which is a growing problem worldwide. The aim of this study was to analyse the prevalence of carbapenem-resistant P. aeruginosa (CRPA) in urine cultures and to determine the risk factors associated with the development of carbapanem resistance.
Material and method. Positive urine cultures to P. aeruginosa between September 2012 and September 2014 were identified. We excluded repetitive cultures from the same patient. We created a database with different variables, including antimicrobial resistance. The prevalence of carbapenem resistance and the risk factors for growth of CRPA were analysed.
Results. Ninety-one patients with positive urine cultures to P. aeruginosa were included. The prevalence of CRPA was 22%. The risk factors to CRPA infection in the univariate analysis were: congestive heart failure (p=0.02), previous treatment with ampicillin (p=0.04), meropenem (p=0.04), piperacillin-tazobactam (p=0.01), trimethoprim-sulfamethoxazole (p= 0.01) and previous treatment with more than one antibiotic (p<0.01). Only congestive heart failure (p<0.01) and previous treatment with more than one antibiotic (p<0.01) showed statistically significant differences in the multivariate analysis. Conclusions. The prevalence of CRPA in urine cultures is high in our population. We should assess the presence of risk factors as previous treatment with more than one antibiotic or comorbidities such as heart failure, in order to select an appropriate empirical treatment in patients with severe urinary tract infections.

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Rev Esp Quimioter 2017; 30(3): 177-182

Prevalence of human papillomavirus in Spanish women from a population screening program

SARA GARCIA, MARTA DOMINGUEZ-GIL, JORGE GAYETE, SILVIA ROJO, JUAN LUIS MUÑOZ, JOSÉ SANTOS SALAS, CELINA ECHEVARRIA, MANUEL BLANCO, CARMEN RAMOS, MÓNICA DE FRUTOS, LUIS LÓPEZ-URRUTIA, LOURDES VIÑUELA, SONIA TAMAMES, PEDRO REDONDO, JOSÉ MARÍA JIMÉNEZ, JOSÉ MARÍA EIROS, RAÚL ORTIZ DE LEJARAZU

Introduction. The human papillomavirus (HPV), is necessary to cause a woman developing cervical cancer. The aim of the study was to estimate the prevalence of women with HPV infection, covered by the program of prevention and early detection of cervical cancer of Castile and León (Spain).
Material and methods. Samples of women included in the screening program were analyzed. Including a total of 120,326 cervical swab samples, collected in the period from January 2012 to December 2014.
Results. 12,183 HPV positive samples were detected, representing a prevalence of 9.6 ‰, (IC 95% 9.5%-9.8%) in the female population. High-risk HPV were found in higher proportion that HPV low-risk genotypes. HPV prevalence correlates inversely with women age. Coinfections of multiple genotypes were found in one third of screened women population.
Conclusions. Data showed in this study are the first and wider Spanish results from a cervical cancer screening program population non opportunistic based on HPV detection. These results would serve as a reference for future prevalence studies and to evaluate the future impact of HPV vaccination campaigns.

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Rev Esp Quimioter 2017; 30(3): 169-176

Strategies to optimize the use of antibiotics in hospitals
JOAQUÍN GÓMEZ, CRISTINA BONILLO, LUIS HUMBERTO NAVARRO, ALICIA HERNÁNDEZ, ELISA GARCÍA VÁZQUEZ
The inadequate use of antibiotics is a clinical reality we are faced with day by day. The great peculiarity of this group of drugs is the in?uence they have not only on the patients and at the time of their use, but also of future infections and the general population, by favoring alterations in the resistance patterns of the bacterial micro?ora that colonize people. It is our obligation as experts in infectious diseases to work on improving the use of antimicrobials.

Rev Esp Quimioter 2017; 30(3): 169-176 [pdf]
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