Rev Esp Quimioter 2017, 30(5): 334-340

Gastrostomy tubes: indications and infectious complications in a tertiary hospital

MARÍA JOSÉ MUÑOZ-DÁVILA, JOSÉ MARÍA XANDRI GRAUPERA, GENOVEVA YAGÜE GUIRAO, CARME SALVADOR GARCÍA, MANUEL SEGOVIA HERNÁNDEZ

Introduction. Gastrostomy tube is the best option for long-term enteral nutrition. Among its limitations, infections represent the most frequent minor complication. Our aim is the knowledge of the number and type of gastrostomy tubes and its main indication in our hospital. In addition, prevalence of infectious complications was studied paying attention to the main etiologic agents and their antibiotic susceptibility.
Methods. Observational retrospective study from January 2010 to July 2015 through the electronic clinical history and the clinical microbiology laboratory software. Identification and antibiotic susceptibility of clinically significant isolates from patients with suspicion of gastrostomy tube infection have been analysed.
Results. Percutaneous endoscopic gastrostomy was performed in 203 patients (70.5%) and surgical gastrostomy in 85 (29.5%). The main reason identified for starting enteral nutrition through gastrostomy tube was malignant neoplasy, above all, lip, oral cavity and pharynx cancer (11.8%) and that from digestive organs (8.7%). Global prevalence of gastrostomy tube infection was 16.6%. The most common bacterial pathogens isolated wereStaphylococcus aureus (21.3%), Pseudomonas aeruginosa (13.1%), and Escherichia coli (9.8%). The percentage of multi resistant isolates was 3.1%.
Conclusions. Gastrostomy tube indications and type, and also, prevalence and microorganisms isolated from culture in infectious complications are similar to those described previously in the literature. The study allows the adaptation of the antibiotic prophylaxis and empirical antibiotic treatment thanks to the knowledge of the etiologic agents and their antibioticsusceptibility.

Rev Esp Quimioter 2017; 30(5): 334-340 [Texto completo – PDF]

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Rev Esp Quimioter 2017, 30(5): 368-371

Importance of the forensic autopsy in the diagnosis of septic shock: a case report

AGUSTÍN SIBÓN-OLANO, ENCARNACIÓN SÁNCHEZ-RODRÍGUEZ, MÓNICA PAYÁ, ESTEFANÍA BARRERA-PÉREZ, MANUEL SALGUERO-VILLADIEGO, AMPARO FERNÁNDEZ-RODRÍGUEZ

Septic shock sometimes starts with unspecific symptoms that hamper the clinical diagnosis and, therefore an appropriate treatment. When the septic shock follows a fulminating course with a fatal outcome, the etiological diagnosis has to be conducted post-mortem. Sudden unexpected deaths in children and young adults are frequently the object of medico-legal autopsies. Some sudden unexpected deaths have an infectious origin, which requires further analyses, including microbiology, to establish the cause of death. Here, the case of a fatal septic shock in a 19-month old male infant is presented. After a mild foot injury, an infection by Streptococcus pyogenes progressed to septic shock with a fatal outcome as post-mortem studies demonstrated.

Rev Esp Quimioter 2017; 30(5): 368-371 [Texto completo – PDF]

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Rev Esp Quimioter 2017, Apr 25

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.

Rev Esp Quimioter 2017; Apr 25 [pdf]

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Rev Esp Quimioter 2017, May 10

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.

Rev Esp Quimioter 2017; May 10 [pdf]

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Rev Esp Quimioter 2017; 30(1):45-49

Evaluation of an immunochromatographic test for the detection of OXA-48 carbapenemase                     

CONCEPCIÓN MEDIAVILLA-GRADOLPH, ROCÍO SÁINZ-RODRIGUEZ, MIRIAM VALVERDE-TROYA, INMACULADA DE TORO-PEINADO, Mª PILAR BERMUDEZ-RUÍZ, BEGOÑA PALOP-BORRÁS           

Introduction. Detection and differentiation of various types of carbapenemases is crucial to their control and dissemination. OXA -48 is the most common carbapenemase in Spain and in our environment. The aim of this study is the evaluation of a new immunochromatographic test OXA-48 Card letitest (Coris, BioConcept Belgium) to detect this carbapenemase from solid media.
Material and Methods. During the last year 151 strains of carbapenemase producing bacteria have been isolated, of which 136 were OXA-48 (126 Klebsiella pneumoniae, 1 Klebsiella oxytoca, 5 Escherichia coli, 4 Enterobacter cloacae), and 15 producing other carbapenemases . These 15 strains with other 73 carrying other resistance mechanisms (54 extended-spectrum β-lactamases producers and 19 with other mechanisms) were used as negative controls.
Results. One hundred and thirty six strains carrying OXA-48 were positive with the test OXA-48 Card letitest and the 88 species used as controls were negative, resulting in a sensitivity and specificity of 100%.
Discussion. The OXA-48 Card letitest is simple, quick, safe and cheap (approx. 6€/test) and can be used in microbiology laboratories to confirm the production of OXA-48 carbapenemase in clinical isolates.

Rev Esp Quimioter 2017; 30(1):45-49  [pdf]

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Rev Esp Quimioter 2017, 30(2):90-95

Resistance rates and phenotypic characterization of Streptococcus pyogenes in a paediatric population in Northern Spain (2005-2015)                     

LAURA CALLE-MIGUEL, CARLOS PÉREZ-MÉNDEZ, MARÍA DOLORES MIGUEL-MARTÍNEZ, EMMA LOMBRAÑA-ÁLVAREZ, ELISA GARCÍA-GARCÍA, GONZALO SOLÍS-SÁNCHEZ           

Background. Streptococcus pyogenes is a significant cause of bacterial infections in children. The aim of the study is to analyse resistance rates and phenotypes of S. pyogenes isolates in a paediatric population in Northern Spain over the last 11 years.
Methods. Descriptive retrospective study of S. pyogenes isolates from paediatric patients between 2005 and 2015 in a region of Asturias (Spain). Resistance rates and changes in erythromycin resistance phenotypes in two time periods (2005-2009 and 2010-2015) were studied.
Results. A total of 1,794 S. pyogenes isolates were registered (70% from 2005 to 2009). 87.5% were obtained from pharyngeal swabs and 0.2% from blood  cultures. Resistance rates to tetracycline (8.8% to 4.3%, p=0.02), erythromycin (22% to 9.3%, p<0.01) and clindamycin (6% to 1.7%, p<0.01) decreased between the two study periods. A reduction in erythromycin-resistant isolates with the MLSB phenotype was observed.
Conclusions. A decrease in S. pyogenes resistance rates to erythromycin and clindamycin and a change in the erythromycin resistance phenotype were observed along the study period.

Rev Esp Quimioter 2017; 30(2):90-95 [pdf]

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Rev Esp Quimioter 2017; 30(1):19-27

Design and implementation of an outpatient parenteral antimicrobial therapy program in primary care: the experience at a second level hospital                     

MARÍA RUIZ-CAMPUZANO, ELISA GARCÍA-VÁZQUEZ, JOSÉ JOAQUÍN HERNÁNDEZ-ROCA, JOAQUÍN GÓMEZ-GÓMEZ, MANUEL CANTERAS-JORDANA, ENRIQUE MENÉ-FENOR, ALICIA HERNÁNDEZ-TORRES, ANA PELÁEZ-BALLESTA           

Introduction. Outpatient parenteral antimicrobial therapy (OPAT) programs are a good assistance option in a wide variety of infectious diseases. Our aim was to design and implement an OPAT program in the area of influence of a second-level hospital, with no Home Hospitalization Service available, being necessary close collaboration between hospitalization and Primary Care teams, describe our cohort, analyse the antimicrobial treatment indicated and evaluate the prognostic and risk factors associated with readmission and mortality. 
Material and methods. Prospective study cohorts of patients admitted to the OPAT programme, from 1 January 2012 to 31 May 2015.
Results. During the period of study a total of 98 episodes were recorded. The average age of the cohort was 66 years. The most frequent comorbidity was immunosuppression (33.67 %), with an overall average of Charlson index of 5.21 ± 3.09. The most common source of infection was respiratory (33.67 %). Microbiological isolation was achieved in fifty-eight patients (59.18 %) being Escherichia coli the most frequently isolated (25%). The average number of days of antibiotics administration at home was 10.42 ± 6.02 (SD), being carbapenems (43.48%) the more administered. Eighty-six patients (87.75%) completed the treatment successfully. Thirty-two patients (32.65%) were readmitted within 30 days after being discharged and seven patients (7.14%) died. A statistically significant association was only found in the readmission with variables: elderly patients (p=0.03), being carriers of Porth-a-Cath (p=0.04) and treatment termination related with infection (p<0.05).
Conclusions. This is the first programme of OPAT administration not dependent on Home Hospitalization Service in Spain, which could allow to optimize the hospital and primary care resources available. Nevertheless this pilot study results are poor in terms of optimization of antibiotics choice, transition to oral administration, de-escalation and duration.

Rev Esp Quimioter 2017; 30(1):19-27  [pdf]

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Rev Esp Quimioter 2017, Mar 8

Usefulness of biomarkers to predict bacteraemia in patients with infection in the emergency department                     

AGUSTÍN JULIÁN-JIMÉNEZ, FRANCISCO JAVIER CANDEL, JUAN GONZÁLEZ-DEL CASTILLO, EN REPRESENTACIÓN DEL GRUPO INFURG-SEMES (GRUPO DE ESTUDIO DE INFECCIONES DE LA SOCIEDAD ESPAÑOLA DE MEDICINA DE URGENCIAS Y EMERGENCIAS)           

Between all patients attended in the Emergency Department (ED), 14.3% have an infectious disease diagnosis. Blood cultures (BC) are obtained in 14.6% of patients and have a profitability of 20%, whereas 1% are considered as contaminated and 1-3% of positive cultures correspond to discharge patients (“hidden bacteraemia”). The highest number of confirmed bacteraemias comes from the samples of patients with urinary tract infections, followed by community-acquired pneumonia. The suspicion and detection of bacteraemia have an important diagnostic and prognostic significance and could modify some important making-decisions (admission, BC request, administration of appropriate and early antimicrobial, etc). Therefore, finding a predictive model of bacteraemia useful and applicable in ED has become the objective of many authors that combine different clinical, epidemiological and analytical variables, including infection and inflammatory response biomarkers (IIRBM), as they significantly increase the predictive power of such models. The aim of this review is to highlight the evidence showed in recent published articles, to clarify existing controversies, and to compare the accuracy of the most important IIRBM to predict bacteremia in patients attended due to infection in the ED. Finally, to generate different recommendations that could help to define the role of IIRBM in improving the indication to obtaining BC, as well as in immediate decision-making in diagnosis and treatment (early and adequate antibiotic treatment, complementary tests, other microbiological samples, hemodynamic support measures, need for admission, etc.).

Rev Esp Quimioter 2017; Mar 8 [pdf]

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Rev Esp Quimioter 2017; 30(1):1-8

Fluoroquinolones: Non-antibacterial properties                     

SOCORRO LEYVA-RAMOS, HIRAM HERNÁNDEZ-LÓPEZ           

Fluoroquinolones are a class of well-established chemotherapeutic agents with a potent biological activity being the structure of 4-quinolone-3-carboxilic acids privileged because it contains different sites for functionalization allowing expand its use in clinical practice for their antifungal, antiviral and anticancer activities. Quinolones structural changes have resulted in a first, second, third and fourth generation of drugs so it is advisable to continue modifying existing structures in new ways to generate compounds with desirable  biological and pharmacological properties.

Rev Esp Quimioter 2017; 30(1):1-8 [pdf]

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Rev Esp Quimioter 2017, Mar 9

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 influence 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 microflora that colonize people. It is our obligation as experts in infectious diseases to work on improving the use of antimicrobials.

Rev Esp Quimioter 2017; Mar 9 [pdf]

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