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.

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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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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]

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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]

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Rev Esp Quimioter 2017; 30(1):14-18

Assessment of antibiotic prophylaxis adequacy in rectal surgery                    

JUAN ANTONIO DEL-MORAL-LUQUE, ENRIQUE COLÁS-RUIZ, PABLO GIL-YONTE, JOSÉ MARÍA FERNÁNDEZ-CEBRIÁN, MARÍA CONCEPCIÓN VILLAR-DEL-CAMPO, ALBERTO DELGADO-IRIBARREN, JOSÉ FRANCISCO VALVERDE-CÁNOVAS, GIL RODRÍGUEZ-CARAVACA           

Introduction. Antibiotic prophylaxis is the most suitable tool for preventing surgical site infection (SSI), so the development of guidelines and assessment of its monitoring is essential. In this study protocol compliance of antibiotic prophylaxis in rectal surgery and the effect of its adequacy in terms of pre-ention of SSI was assessed.
Material and methods. Prospective cohort study was conducted from 1 January 2009 to 30 December 2015. The degree of compliance with antibiotic prophylaxis and causes of non-compliance in rectal surgery was evaluated. The incidence of SSI was studied after a maximum period of 30 days of incubation. To assess the effect of prophylaxis non-compliance on SSI the relative risk (RR) adjusted with the aid of a logistic regression model was used.
Results. The study covered a total of 244 patients. The patients infected reached 20 cases with a SSI cumulative incidence of 8.2% (CI95%: 4.8-11.6). Antibiotic prophylaxis was indicated in all patients and was administered in 98% of cases, with an overall protocol compliance 92.5%. The principal cause of non-compliance was the choice of antibiotic 55.6% (n=10). The effect of inadequacy of antibiotic prophylaxis on surgical infection was RR=0.58, CI95%: 0.10-4.10 (P>0.05).
Conclusions. Compliance with antibiotic prophylaxis was high. No relationship between the adequacy of prophylaxis and incidence of surgical site infection in rectal surgery was found.

Rev Esp Quimioter 2017; 30(1):14-18  [pdf]

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Rev Esp Quimioter 2017, Mar 29

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..

Rev Esp Quimioter 2017; Mar 29 [pdf]

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Rev Esp Quimioter 2017; 30(1):28-33

Epidemiology and risk factors of patients with intra-abdominal postsurgical infection treated with tigecycline: a cohort study                    

GLORIA TORRES, MIRIAM PAREDES, ALICIA HERNÁNDEZ, CRISTINA GARCÍA, FRANCISCO SÁNCHEZ BUENO, MANUEL CANTERAS, PASCUAL PARRILLA, JOAQUÍN GÓMEZ           

Objectives. To study a cohort of patients with intra-abdominal postsurgical infection treated with tigecycline to analyze its effectiveness and mortality related factors.
Patients and methods.  Prospective study of patients with intra-abdominal postsurgical infection with microbiological isolation and treated with tigecycline.
Results. Out of 103 patients only 61 full fit inclusion criteria. Mean age was 67 year-old and 72% were male. Charlson score was ≥ 3 in 65.5%, being diabetes and colon cancer the most prevalent diseases. Cancer surgery was the most frequent procedure (n=44, 72%) and previous antibiotic administration was present in 43 cases (69%). Pitt score was ≥ 3 in 69% and most prevalent bacteria were Escherichia coli (38 %), Enterococcus spp. (34%; mainly Enterococcus faecium) and Klebsiella pneumoniae together with Enterobacter cloacae (28%). Tigecycline was prescribed alone (17; 28%) or in combination with other antibiotics (44; 72%), mainly meropenem (25; 57%) or amikacin (19, 43%). 11 patients died (18%), all of which suffered extended cancer surgery and isolation of extended-spectrum betalactamase producing Enterobacteriaceae. Factors statistically associated to death in univariate analysis were Charlson score >3, pH <7.3 and leucocyte count >20.000 cells/mm3.
Conclusions. As being a cohort of patients treated with tigecycline, E. faecium isolation was very frequent. Non-fatal evolution was achieved in 82% cases, being tigecycline a potentially good option in the empiric treatment of very severe infections.

Rev Esp Quimioter 2017; 30(1):28-33 [pdf]

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