, ,

Rev Esp Quimioter 2018; 31(6): 528-531

Fake imported tropical diseases: A retrospective study

ÁNGELA ROMERO-ALEGRÍA, MICHELE HERNANDEZ CABRERA, VIRGINIA VELASCO-TIRADO, ELENA PISOS ÁLAMO, JAVIER PARDO-LLEDÍAS, NIEVES JAÉN SÁNCHEZ, MONCEF BELHASSEN-GARCÍA, JOSÉ LUIS PÉREZ ARELLANO

Background. When we evaluate a patient with a suspected imported disease we cannot forget to include any autochthonous causes that may mimic imported pathologies to avoid misdiagnosis and therapeutic delay.
Methods. A descriptive longitudinal retrospective study was designed with patients in whom an imported disease was suspected but who were finally diagnosed with autochthonous processes. The patients were selected from two internal medicine practices specializing in tropical diseases between 2008-2017 in Spain.
Results. We report 16 patients, 11 (68.7%) were males, and the mean age was 43.4 ± 13.7 years old. Thirteen patients (81.2%) were travellers. Half of the patients were from Latin America, 7 (43.5%) were from Africa, and 1 (6.2%) was from Asia. The time from trip to evaluation ranged between 1 week and 20 years (median, 4 weeks), and the mean time from evaluation to diagnosis was 58.4 ± 100.9 days. There were 5 (31.2%) cases of autochthonous infection, 5 (31.2%) cases of cancer, 2 (12.5%) cases of inflammatory disease, and 2 (12.5%) cases of vascular disease.
Conclusions. Travel or migration by a patient can sometimes be a confusing factor if an imported disease is suspected and may cause delays in the diagnosis and treatment of an autochthonous disease. We highlight that 1/3 of the patients with autochthonous diseases in this study had cancer. The evaluation of imported diseases requires a comprehensive approach by the internist, especially if he specializes in infectious and/or tropical diseases and is, therefore, the best qualified to make an accurate diagnosis.

Rev Esp Quimioter 2018; 31(6): 528-531  [Full-text PDF]

/por
,

Rev Esp Quimioter 2018; 31(5):461-484

Integral approach to the acute exacerbation of chronic obstructive pulmonary disease

JUAN GONZÁLEZ DEL CASTILLO, FRANCISCO JAVIER CANDEL, JAVIER DE LA FUENTE, FEDERICO GORDO, FRANCISCO JAVIER MARTÍN-SÁNCHEZ, ROSARIO MENÉNDEZ, ABEL MUJAL, JOSÉ BARBERÁN

Chronic obstructive pulmonary disease is a set of clinical processes that have in common a chronic and progressive obstruction to airflow, with episodes of exacerbation. These exacerbations are more frequent and severe over time, deteriorating the lung function. The main cause of exacerbations is bacterial infection. There are multiple guidelines and documents that statement the management of this pathology. However, they focus primarily on the treatment during the stable phase. This document addresses the problem of acute exacerbation due to an infection from a multidisciplinary perspective, focusing on the integral approach to the process, and including etiology, microbiological studies, resistance to antimicrobials, risk stratification and initial empirical therapeutic management (antibiotic and concomitant). In addition, it includes an approach to more complex aspects such as the management of special populations (elderly and immunosuppressed) or therapeutic failure. Finally, more controversial topics such as prophylaxis of infection or palliative treatment are specifically discussed.

Rev Esp Quimioter 2018; 31(5):461-484 [Texto completo PDF]

/por
,

Rev Esp Quimioter 2018; 31(5):439-442

Kingella kingae as a common cause of arthritis septic in children

MARTA ILLÁN-RAMOS, SARA GUILLÉN-MARTÍN, LUIS MANUEL PRIETO-TATO, JUANA BEGOÑA CACHO-CALVO, FERNANDO GONZÁLEZ-ROMO, LAURA FRANCISCO-GONZÁLEZ, JOSÉ TOMÁS RAMOS-AMADOR

Introduction. Kingella kingae is a common colonizer of the oropharynx in children that may lead to invasive infection, mainly osteoarticular infections. Invasive infections occur almost exclusively in young children, fundamentally fewer than two years old. K. kingae infections in children are probably underdiagnosed due to the difficulty in growing in routine cultures and the absence of systematic realization of molecular techniques to identify it. It is the most common bacteria involved in childhood osteoarticular infections in recent series and increasingly being recognized in Spain. We report our experience on the epidemiological and clinical characteristics of osteoarticular infections in children in recent years.
Patients and methods. Retrospective analysis of septic arthritis by K. kingae identified by PCR in joint fluid in children during 2010-2016. Epidemiological, clinical and laboratory characteristics are presented.
Results. Five arthritis by K. kingae were identified, all of them in ≤6 years old children. Median leukocytes, CRP and ESR were 12950 leukocytes/μL, 4.84 mg/dL and 58 mm/h respectively, and 61,322 leukocytes /μL in joint fluid. All patients evolved favorably.
Conclusions. Osteoarticular infections by K. kingae in children usually present low increase of inflammatory markers despite being invasive infections. The development of PCR in sterile samples has greatly improved the diagnostic yield of K. kingae infections improving the management of osteoarthritis in children.

Rev Esp Quimioter 2018; 31(5):439-442 [Texto completo PDF]

/por
,

Rev Esp Quimioter 2018; 31(5):435-438

Comparison of culture, microscopic smear and molecular methods in diagnosis of tuberculosis

ILHAN AFSAR, MERYEM GUNES, HAKAN ER, ASLI GAMZE SENER

Objectives. Tuberculosis (TB) is a public health problem worldwide, with the highest mortality . The development of nucleic acid-based tests for detection of Mycobacterium tuberculosis complex (MTBC) has significantly increased sensitivity compared to conventional smear microscopy and provides results within a matter of hours compared to weeks for solid culture, which is the current gold standart. The aim of this study was to compare the culture, microscopic smear and molecular method in the diagnosis of TB .
Material and methods. Seven hundred ninety specimens belonging to clinically suspected cases of TB were studied retrospectively. The specimens were grouped as respiratory and non-respiratory and the groups were compared for mycobacterial detection assays. The culture and the molecular diagnostic GeneXpert MTB/RIF (GX) assay method were compared.
Results. When culture was used as the reference standart, 32 (4.05%) specimens were positive for MTBC. Of the 32 culture positive clinical specimens 24 (3.03%) were respiratory and 8 (1.01%) were non-respiratory specimens. All 24 of the 24 respiratory specimens were positive by the GX test, Seven of the eight non-respiratory specimens positive for culture were positive by GX assay. Five of the seven hundred fifty-eight samples of culture negative were positive with GX assay. Sensitivity and specificity of GX were found to be 96.8 % and 99.3 %, respectively.
Concluisons. Molecular methods to acquire time in diagnosis as well as the increase in linearity gives a different perspective to the diagnosis of tuberculosis. The GX assay has a diagnostic utility for rapid diagnosis of TB.

Rev Esp Quimioter 2018; 31(5):435-438 [Full-text PDF]

/por
,

Rev Esp Quimioter 2018; 31(5):427-434

Risk factors and clinical evolution of carbapenemase-producing Klebsiella pneumoniae infections in a university hospital in Spain. Case-control study

VÍCTOR ROJO, PEDRO VÁZQUEZ, SAGRARIO REYES, LUCÍA PUENTE FUERTES, MIGUEL CERVERO

Introduction. Carbapenemase-producing Enterobacterias is a global health hazard due to their ease of transmission, difficulty of treatment, and their personal and economic impact. We analyze the factors associated with an increased risk of infection by Klebsiella pneumoniae carbapenemase-producing bacteria (KPC) and factors related to poor prognosis.
Materials and methods. We designed a case-control study. KPC isolates were taken during an outbreak in a hospital in Madrid. A logistic regression was performed with the main variables.
Results. Sixteen cases of clinically documented infections were isolated. Overall mortality rates in the cases group was 25%. The most frequent location was blood (37.5%) followed by urine (25%). All but one were OXA-48. Regarding factors related to an increased risk of developing infection, only previous exposure to antibiotics presented statistical significance difference OR 13 (2.40-70.46). With respect to the overall mortality, the presence of pneumonia OR 25 (1.93-323.55) or the use of invasive mechanical ventilation was associated with greater risk 15 OR 33 (1.92-122.8) For attributable mortality only invasive ventilation had a significant association OR 18 (1.48-218.95).
Conclusions. Exposure to previous antibiotics is an independent risk factor for developing KPC infection, adjusted for all other clinical and demographic variables. Risk factors such as the presence of pneumonia or the use of invasive mechanical ventilation were associated with a worse prognosis in terms of overall and attributable mortality.

Rev Esp Quimioter 2018; 31(5):427-434 [Texto completo PDF]

/por
,

Rev Esp Quimioter 2018; 31(5):411-418

Fecal microbiota transplantation for recurrent Clostridium difficile infection: Experience, protocol, and results

ELENA REIGADAS, MARÍA OLMEDO, MARICELA VALERIO, SILVIA VÁZQUEZ-CUESTA, LUIS ALCALÁ, MERCEDES MARÍN, PATRICIA MUÑOZ, EMILIO BOUZA

Background. Fecal microbiota transplantation (FMT) is a highly effective therapy for recurrent Clostridium difficile infection (R-CDI). Despite its excellent efficacy, it is still not a routine procedure in most European centers. FMT has not been widely used in Spain to date. We describe our experience with FMT, including a novel approach based on oral fecal capsules.
Methods. We analyzed a prospectively recorded case series of patients with R-CDI treated with FMT at a single center (June 2014-July 2017). Primary outcome was defined as resolution of CDI without recurrence in a two-month period. FMT was administered via colonoscopy, nasojejunal tube, or oral capsules. All stool donors were rigorously screened.
Results. FMT was performed in 13 patients with R-CDI. Median age was 75.0 years and 76.9% were females. Six FMT were performed via nasojejunal tube, 5 via oral capsules, and 2 by colonoscopy. There were no procedure-related adverse events, except for bacteremia in one patient. During follow-up, R- CDI was observed in one patient at one month after FMT. The primary resolution rate was 83.3% and the overall resolution rate was 91.7%. FMT by capsules achieved a 100% resolution rate, colonoscopy 100%, and nasojejunal tube 80.0%.
Conclusions. In our cohort, FMT proved to be safe and effective, even in high risk patients. Oral administration in capsules also proved to be safe, well-tolerated, and highly effective for R-CDI. In our experience, the FMT capsule formulation seems feasible in the routine of a hospital. This administration method will allow FMT to be more widely used.

Rev Esp Quimioter 2018; 31(5):411-418 [Full-text PDF]

/por
,

Rev Esp Quimioter 2018; 31(5):406-410

Colistin resistance due to insertional inactivation of the mgrB in Klebsiella pneumoniae of clinical origin: First report from India

ANIL KUMAR, LALITHA BISWAS, NEHA OMGY, KARTHIKA MOHAN, VIVEK VINOD, ANJALI SAJEEV, PREM NAIR, SANJEEV SINGH, RAJA BISWAS

Objectives. Mutations in mgrB, phoP/phoQ, pmrA, pmrB, pmrC, and crrABC regulatory systems have been found responsible for colistin resistance. The aim of our study was to investigate the role of alteration in mgrB gene and plasmid mediate mcr-1 and mcr-2 genes as a source of colistin resistance in 17 non duplicate Klebsiella pneumoniae clinical isolates.
Methods. All isolates classified as resistant to colistin by VITEK 2 system (BioMerieux, Marcy I’ Etoile, France) were included. Susceptibility to colistin was also determined by broth microdilution using breakpoints recommended by EUCAST (>2mg/L resistant; and ≤2mg/L susceptible). PCR amplification of mgrB gene was performed and sequenced using specific primers. Presence of mcr-1 and mcr-2 was also investigated using PCR.
Results. PCR amplification of the mgrB gene of the 17 K.pneumoniae isolates revealed a larger (~1000bp) amplicon in three isolates when compared with the wild type mgrB ampiclon (250 bp). Sequencing of these amplicons showed that mgrB was disrupted by the insertion of ISKpn14, a IS element belonging to the IS1 family. Sequencing, of the 250 bp mgrB gene in the remaining 14 isolates revealed frame shift mutation after the second codon leading to a premature stop codon in only one isolate.
Conclusions. The study showed that colistin resistance in 20% of the K. pneumoniae isolates was due to loss of function of mgrB. We describe for the first-time from India, insertional inactivation of mgrB by ISKpn14 inserted at different sites, responsible for colistin resistance.

Rev Esp Quimioter 2018; 31(5):406-410 [Full-text PDF]

/por
,

Rev Esp Quimioter 2018; 31(5):419-426

Antimicrobial stewardship programme implementation in a medical ward

JESÚS RUIZ, MIGUEL SALAVERT, PAULA RAMÍREZ, MARTA MONTERO, IVÁN CASTRO, EVA GONZÁLEZ, EVA ROMÁ, JOSÉ LUIS POVEDA

Introduction. Antimicrobial stewardship programmes (ASP) have proven to be effective tools for reducing the use of antimicrobials. The purpose of the study is to evaluate the effect of an ASP implantation in a medical Ward.
Material and methods. Prospective intervention study in a medical ward with a heterogeneous composition. In September 2014, an ASP based on prospective audits was implemented. Antimicrobial consumption and the length of stay and mortality in all patients admitted, as well as in the main infections present in the unit, were compared before and after two years of the ASP implementation.
Results. A total of 378 infectious episodes of 335 pa-tients were evaluated in 168 meetings. The prescriber ac-cepted 92.3% of the suggestions. The consumption of an-timicrobials reviewed was reduced from 31.3 to 17.6 DDD / 100-stays (β =-0.40, P = 0.015). The average cost per income was reduced from € 161.4 to € 123.3 (-23.6%). No differences were found in total length of stay or mortality. There were no changes in the incidence of Clostridium difficile infection or candidemia between the two periods. There were no significant differences in length of stay or mortality in total bacteremia, candidemia, and urinary tract infections caused by multiresistant bacteria.
Conclusions. The implementation of an ASP in a heterogeneous medical ward significantly reduces the use of antimicrobials in a short time horizon without adversely affecting the evolution of the patients.

Rev Esp Quimioter 2018; 31(5):419-426 [Texto completo PDF]

/por
,

Rev Esp Quimioter 2018; 31 (Suppl. 1): 62-65

Top-ten papers in Infection Control (2015-2017)

BEATRIZ DIETL, ESTHER CALBO

Healthcare-associated infections are a main Public Health challenge. In the era of antimicrobial resistance, more effective Infection Control Programs are needed. In this review we will discuss some publications related to hand hygiene (should the patients participate in the improvement programs?); some new strategies to enhance terminal room disinfection and important controversies on contact precautions policies (should we abandon them?). In the last year, there have been as well some reports that provide new insights in Clostridium difficile infection and in the impact of educational antimicrobial stewardship programs.

Rev Esp Quimioter 2018; 31(Suppl. 1): 62-65 [Full-text PDF]

/por
,

Rev Esp Quimioter 2018; 31 (Suppl. 1): 56-61

Central nervous system infections in immunocompromised patients

IVÁN CASTRO, JESÚS RUIZ, MARÍA TASIAS, MARTA MONTERO, MIGUEL SALAVERT

Diagnosis of CNS infections remains a great challenge in immunocompromised patients with solid cancer or hematological disorders, as it happens with transplant recipients, since symptoms might both be masked and be mimicked by other conditions such as metabolic disturbances or consequences of antineoplastic treatment and the administration of immunosuppressive drugs. Thus, awareness of this complication is crucial and any suspicion of a CNS infection should lead to make an early diagnosis and to choose an appropriate empirical treatment to improve the outcome in this population.

Rev Esp Quimioter 2018; 31(Suppl. 1): 56-61 [Full-text PDF]

/por