Rev Esp Quimioter 2017; 30(1):9-13

Time-to-positivity, type of culture media and oxidase test performed on positive blood culture vials to predict Pseudomonas aeruginosa in patients with Gram-negative bacilli bacteraemia                     

NAZARET COBOS-TRIGUEROS, YULIYA ZBOROMYRSKA, LAURA MORATA, IZASKUN ALEJO, CRISTINA DE LA CALLE, ANDREA VERGARA, CELIA CARDOZO, MARIA P. ARCAS, ALEX SORIANO, FRANCESC MARCO, JOSEP MENSA, MANEL ALMELA, JOSE A. MARTINEZ           

Introduction. The aim of this study was to determine the usefulness of oxidase test and time-to-positivity (TTP) in aerobic and anaerobic blood culture vials to detect the presence of Pseudomonas aeruginosa in patients with Gram-negative bacilli (GNB) bacteraemia.
Material and methods. TTP was recorded for each aerobic and anaerobic blood culture vial of monomicrobial bacteraemia due to GNB. Oxidase test was performed in a pellet of the centrifuged content of the positive blood culture. An algorithm was developed in order to perform the oxidase test efficiently taking into account TTP and type of vial.
Results. A total of 341 episodes of GNB bacteraemia were analysed. Sensitivity, specificity, positive predictive value and negative predictive value of the oxidase test performed on positive vials with GNB to predict P. aeruginosa were 95%, 99%, 91%, and 99%, respectively.  When growth was first or exclusively detected in anaerobic vials, P. aeruginosa was never identified hence the performance of the oxidase test could be avoided. When growth was only or first detected in aerobic vials, a TTP≥8h predicted P. aeruginosa in 37% or cases (63 of 169), therefore oxidase test is highly recommended.
Conclusions. Oxidase test performed onto positive blood culture vials previously selected by TTP and type of vials is an easy and inexpensive way to predict P. aeruginosa. In most cases, this can lead to optimization of treatment in less than 24 hours.

Rev Esp Quimioter 2017; 30(1):9-13  [pdf]

/por

Rev Esp Quimioter 2017, 30(2):96-102

Non-febrile syndromes in the traveler returning from tropical regions admitted in a monographic unit                     

ÁLVARO ANULA-MORALES, BÁRBARA MARTIN-GINER, MICHELE HERNÁNDEZ-CABRERA, CRISTINA CARRANZA-RODRÍGUEZ, ELENA PISOS-ÁLAMO, NIEVES JAÉN-SÁNCHEZ, JOSÉ-LUIS PÉREZ-ARELLANO           

 

Background. The aim was to analyse those syndromes without 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 without fever (n = 281), 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 281 international travellers presenting without fever were analysed. Only 39% had received health counsel prior to travelling. The most visited regions were Lat-in America (38.8%), Africa (37.8%) and Asia (13.6%). 15% of patients were asymptomatic or suffered from non-infectious conditions. Among the rest, most had either gastrointestinal (46%) or cutaneous (34%) syndromes. The main gastrointestinal condition was diarrhoea, with a microbiological diagnosis reached in almost 50% of cases. Regarding cutaneous syndromes, arthropods bites (31%) and different bacterial lesions (20%) were most common.
Conclusions. Approximately 10% of patients in Travel Medicine are international travellers returning from tropical regions, half of them with no fever. Most are diagnosed with infectious diseases, mainly gastrointestinal or cutaneous syn-dromes. Eosinophilia is the third problem in frequency among this group of patients, and sexually transmitted infections are rare in our cohort. It is important to emphasize in preventive activities.

Rev Esp Quimioter 2017; 30(2):96-102  [pdf]

/por

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]

/por

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]

/por

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]

/por

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]

/por

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]

/por

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]

/por

Rev Esp Quimioter 2017; 30(1):40-44

Comparative study of HIV-1/2 antibody confirmatory assay: Geenius™ versus INNO-LIA™                    

AITZIBER AGUINAGA ANA NAVASCUÉS ISABEL POLO CARMEN EZPELETA           

Introduction. The aim of the study is to compare two confirmatory tests for HIV-1/2 infection.
Material and methods. A prospective study was carried out between 01/01/2015 and 12/31/2015. Serum samples with repeatedly positive results in the Antibody-Antigen-HIV-1/2 (Architect, Abbott) screening assay were included. The serum samples corresponding to new diagnosed cases were selected and were used to compare the two confirmatory assays: Geenius™ HIV-1/2 (Bio-Rad) and INNO-LIA™ HIV-1/2 score line-immunoassay (Innogene-tics®). The HIV-1 viral load (Cobas® AmpliPrepHIV, Ro-che) was performed in discordant or indeterminate cases.
Results. Eight five samples were included. The results of both confirmatory assays were concordant in 80/85 samples: 53 HIV-1, 1 HIV-2, 25 negative and one indeterminate. Cohen’s Kappa concordance coefficient between Geenius™ and INNO-LIA™ techniques was very high (0.878).
Conclusion. The concordance between the two assays is high. The procedure for Geenius™ is simple and fast. Geenius™ is a good alternative to include in the HIV-1/2 diagnostic algorithm.

Rev Esp Quimioter 2017; 30(1):40-44  [pdf]

/por

Rev Esp Quimioter 2017, Mar 29

Ceftolozane-tazobactam for the treatment of ventilator-associated infections by colistin-resistant Pseudomonas aeruginosa                     

FRANCISCO ÁLVAREZ LERMA, ROSANA MUÑOZ BERMÚDEZ, SANTIAGO GRAU, MARÍA PILAR GRACIA ARNILLAS, LUISA SORLI, LLUIS RECASENS, MIQUEL MICO GARCÍA           

The use of colistin for the treatment of multiresistant bacteria has led to the emergence of colistin-resistant strains of Gram-negative bacilli. Treatment of infections caused by these pan–drug-resistant bacteria is difficult owing to the paucity of effective antibiotics. We report two cases of ventilator-associated respiratory infection caused by pan–drug-resistant, colistin-resistant Pseudomonas aeruginosa that were successfully treated with ceftolozane-tazobactam.

Rev Esp Quimioter 2017; Mar 29 [pdf]

/por