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Rev Esp Quimioter 2018; 31(2): 160-163

First clinical isolation report of Shewanella algae from the stools of a patient with acute enteritis in Spain

ELEAZAR FERNÁNDEZ-FERNÁNDEZ, ALBERTO J. MARTÍN-RODRÍGUEZ, MARIANO HERNÁNDEZ, JOSÉ MARÍA NAVARRO-MARÍ, UTE RÖMLING, JOSÉ GUTIÉRREZ-FERNÁNDEZ

We report a case of acute enteritis caused by Shewanella algae in a cirrhotic patient. Biochemical identification systems revealed to be insufficient to identify the Shewanella isolate at the species level, thus requiring 16S rRNA and gyrB partial gene sequencing. Even if co-infection by Clostridium difficile could not be ruled out, this is, to our knowledge, the first report of acute enteritis caused by Shewanella algae in Europe.

Rev Esp Quimioter 2018; 31(2): 160-163 [Full-text PDF]

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Rev Esp Quimioter 2018; 31(2): 146-151

Clinical and microbiologic characteristics of pleuro-pulmonary infection due to Streptococcus intermedius

FERNANDO COBO, ANTONIO SAMPEDRO, JAVIER RODRÍGUEZ-GRANGER, LUIS ALIAGA-MARTÍNEZ, JOSÉ MARÍA NAVARRO-MARÍ

The clinical and microbiological characteristics of pleuro-pulmonary infection (PPI) caused by Streptococcus intermedius is described, including 6 cases in the literature and 9 cases handled at the present centre. Out of the 15 patients, 12 were male; mean age at diagnosis was 62.06 ± 15 years. Twelve had risk factors for S. intermedius infection such as alcoholism in 5 (35.7%) patients, periodontal disease in 3 (24.6%) cases, chronic obstructive pulmonary disease in 3 (24.6%), and diabetes mellitus in 2 (14.2%). Cough was present in 12 (80%) patients and chest pain and dyspnea in 9 (60%). The mean diagnosis interval was 34 days. The diagnosis was obtained from pleural fluid aspirate in 13 (86.6%) cases and from biopsy/tissue samples in 2. The most frequently antimicrobials used for treatment were ceftriaxone + levofloxacin. Ten patients cured with a combination of medical and surgical treatment and 2 patients died as a consequence of infection. The incidence of PPI caused by S. intermedius is increasing in our health area; drainage along with antibiotic therapy is recommended for treatment.

Rev Esp Quimioter 2018; 31(2): 146-151 [Full-text PDF]

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Rev Esp Quimioter 2018; 31(2): 123-130.

Nosocomial infections caused by multiresistant Pseudomonas aeruginosa (carbapenems included): predictive and prognostic factors. A prospective study (2016-2017)

ALICIA HERNÁNDEZ, GENOVEVA YAGÜE, ELISA GARCÍA VÁZQUEZ, MARINA SIMÓN, LAURA MORENO PARRADO, MANUEL CANTERAS, JOAQUÍN GÓMEZ

Introduction. Pseudomonas aeruginosa is one of the major pathogens causing hospital-acquired infections. In recent years, antimicrobial resistance is increasing and multidrug resistant (MDR) and extremely drug resistant (XDR) isolates have been associated with an increase of mortality. The aim of this study is to assess the clinical significance and analyze predictors and prognostic factors.
Methods. Prospective case-control non-paired study involving 64 patients with P. aeruginosa nosocomial infection, 32 caused by susceptible P. aeruginosa and 32 by MDR/XDR including to carbapenems (XDR-C) strains, admitted at a third level hospital. The follow-up period was till hospital discharge or death and at 30 days after discharge. For all patients, clinical epidemiology and microbiological data were analyzed.
Results. The incidence of MDR/XDR-C strains was 2.3 per 1000 admissions. Ten of which were VIM metallo-β-lactamase–producing. Independent predictor factors associated with MDR/XDR-C infections were: previous ICU or Resuscitation unit admission (OR 14.01; IC 95% 2.105-93.297) appearance >20 days after admission (OR 29.826; IC 95% 4.783-185.997) and leukocytosis (OR 10.0190; IC 95% 1.842-56.369). However, there were not statistically significant differences in clinical severity or mortality between both groups.
Conclusión. The major risk factors associated with MDR/XDR-C infections were previous ICU or Resuscitation unit admission, appearance >20 days after admission and leukocytosis. MDR/XDR-C infections were not associated to increased mortality.

Rev Esp Quimioter 2018; 31(2): 123-130. [Texto completo PDF]

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Rev Esp Quimioter 2018; 31(2): 156-159

Monophasic Salmonella Typhimurium outbreak due to the consumption of roast pork meat

MÓNICA DE FRUTOS, LUIS LÓPEZ-URRUTIA, CLARA BERBEL, MARTA ALLUE, SILVIA HERRERA, JOSÉ MANUEL AZCONA, XABIER BERISTAÍN, ESTEBAN AZNAR, MIRIAM ALBERT, CRISTINA RUIZ, JOSÉ MARÍA EIROS

This report presents an outbreak of monophasic Salmonella enteric serovar Typhimurium fagotipe 4, 5, 12: i:-, in a motorcycle concentration in Valladolid. Information was collected to one hundred and twelve affected from seven Spanish Autonomous Communities. The epidemiological investigation associated the outbreak with the consumption of roast pork with sauce sandwiches sold at a street market in that event.

Rev Esp Quimioter 2018; 31(2): 156-159 [Texto completo PDF]

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Rev Esp Quimioter 2018; 31(2): 152-155

A current overview of the teaching of Tropical Medicine, International Health and Global Health in the Spanish university

MIGUEL CABRERO-DE CABO, JOSÉ M. RAMOS-RINCÓN, MIGUEL GÓRGOLAS-HERNÁNDEZ MORA

Background. The teaching of tropical medicine, international health or global health in the Spanish Schools of Medicine and Pharmacy is unknown. The objective of this study is to show a current overview of teaching in degree and post-graduate.
Material and methods. The curricula are reviewed, identifying those subjects and postgraduate courses with the denomination “Tropical Medicine”, “International Health”, “Global Health” or “Imported Diseases”
Results. In 15 of the 40 (37.5%) schools of Medicine the subject of Tropical Medicine, International Health or Global Health is taught during the degree. In 14 of them (93.3%) with an optional character and in one (6.7%) with obligatory character. In 4 out of 22 (18.1%) Pharmacy schools are taught in the degree of Tropical Medicine, International Health or Global Health.
Conclusions. The teaching in Tropical Medicine, International Health and Global Health in the Schools of Medicine and Pharmacy in Spain has, currently, a limited presence.

Rev Esp Quimioter 2018; 31(2): 152-155 [Texto completo PDF]

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Rev Esp Quimioter 2018; 31(2): 105-109

Use of hepatitis B AS04C adjuvanted vaccine in HIV patients

MARÍA FERNÁNDEZ-PRADA, OMAR DARÍO RODRÍGUEZ-FONSECA, ANAHY MARÍA BRANDY-GARCÍA, PAULA ALONSO-PENANES, ISMAEL HUERTA-GONZÁLEZ, FEDERICO FERNÁNDEZ-NOVAL

Introduction. Co-infection with hepatitis B virus (HBV) in patients with human immunodeficiency virus (HIV) increases associated morbidity and mortality. Vaccination against HBV has been shown to be the most effective method to prevent this situation. Standard vaccination schemes used in this population do not appear to be effective enough. The objective is to identify the response rate following the use of AS04C-adjuvanted hepatitis B vaccine in HIV patients as well as the possible associated adverse reactions.
Methods. An observational, analytical study with a retrospective cohort of HIV positive patients discharged in 2016 from the Vaccines Unit of a Preventive Medicine and Public Health Service. Patients with antiHBs (-), antiHBcActot (-) and HBsAg (-) at baseline were included, none of them had received prior HBV vaccination. HBV adjuvanted vaccine was used in a 4-dose regimen (0-1-2-6 months). When antiHBs was <10 IU/mL after primovaccination, two additional doses of the same vaccine were applied with an interval of 30 days.
Results. A total of 39 patients were included. Of them, 74.4% were men. The mean age was 47.26 years. The response rate after primary vaccination was higher than 92% and up to 100% with the two subsequent doses. No adverse reactions were reported.
Conclusion. The administration of AS04C-adjuvanted hepatitis B vaccine in HIV patients showed a 100% response rate, showing an excellent safety profile.

Rev Esp Quimioter 2018; 31(2): 105-109 [Texto completo PDF]

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Rev Esp Quimioter 2018; 31(2): 118-122

Prophylactic antibiotherapy in hip arthroplasty. Cohort study

MARÍA GARROTE-GARROTE, JUAN ANTONIO DEL-MORAL-LUQUE, ANTONIO CHECA-GARCÍA, JOSÉ FRANCISCO VALVERDE-CÁNOVAS, CAROLINA CAMPELO-GUTIÉRREZ, JAVIER MARTÍNEZ-MARTÍN, ÁNGEL GIL-DE-MIGUEL, GIL RODRÍGUEZ-CARAVACA

Introduction. The surgical site infection is the main cause of nosocomial infection in surgical patients, being antibiotic prophylaxis one of the most important factors for preventing it. This study evaluates adequacy of antibiotic prophylaxis in hip arthroplasty surgery as well as its effect on preventing surgical site infection.
Material and methods. A prospective cohort study was carried out from January 2011 to December 2016. We assessed the degree of adequacy of antibiotic prophylaxis in hip arthroplasty. Incidence of surgical site infection was studied after a maximum incubation period of 90 days. In order to assess the effect of inadequate prophylaxis on surgical site infection we used the relative risk adjusted with a logistic regression model.
Results. We studied 681 patients. Incidence of surgical site infection was 4% (95% CI 2.5-5.5). Antibiotic prophylaxis was administered in 99% of cases, with an overall protocol adequacy of 74%. The main cause of non-compliance was the length of prescription (22.2%; 149 patients). The effect of inadequate prophylaxis on surgical site infection was RRadjusted=0.47; 95%CI 0.19-1.17, (p>0.05).
Conclusions. Adequacy of antibiotic prophylaxis was high. No relationship between prophylaxis adequacy and incidence of surgical site infection was founded. Surveillance allows us to assess surgical site infection and risk factors.

Rev Esp Quimioter 2018; 31(2): 118-122 [Texto completo PDF]

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Rev Esp Quimioter 2018; 31(2): 136-145

Antimicrobial susceptibility trends and evolution of isolates with extended spectrum β-lactamases among Gram-negative organisms recovered during the SMART study in Spain (2011-2015)

RAFAEL CANTÓN, ELENA LOZA, JAVIER AZNAR, RUBÉN BARRÓN-ADÚRIZ, JORGE CALVO, F. JAVIER CASTILLO, EMILIA CERCENADO, RAMÓN CISTERNA, FERNANDO GONZÁLEZ-ROMO, JOSÉ LUIS LÓPEZ-HONTANGAS, ANA ISABEL SUÁREZ-BARRENECHEA, FE TUBAU, BRIAN MOLLOY, DIEGO LÓPEZ-MENDOZA, AND SMART-SPAIN WORKING GROUP

Introduction. The SMART (Study for Monitoring Antimicrobial Resistance Trends) surveillance study monitors antimicrobial susceptibility and extended spectrum β-lactamases (ESBLs) in Gram-negative bacilli recovered from intra-abdominal infections (IAI).
Material and methods. Antimicrobial susceptibility of 5,343 isolates from IAI recovered in 11 centres during the 2011-2015 SMART-Spain program was analysed by standard microdilution (EUCAST criteria) and compared with that from 2002-2010. ESBLs were phenotypically detected.
Results. Escherichia coli, the most common isolate, significantly decreased in community acquired IAI (60.9% 2002-2010 vs. 56.1% 2011-2015, P=0.0003). It was followed in prevalence by Klebsiella pneumoniae that increased both in the community (8.9% vs. 10.8%, P=0.016) and nosocomial (9.2% vs. 10.8%, P=0.029) IAI and P. aeruginosa, which significantly increased in community acquired IAI (5.6% vs. 8.0%, P=0.0003). ESBLs were more prevalent in K. pneumoniae (16.3%) than in E. coli (9.5%) of nosocomial origin and were more frequently isolated from elderly patients (>60 years). Considering all Enterobacteriaceae, ertapenem (92.3-100%) and amikacin (95.5%-100%) were the most active antimicrobials. Ertapenem activity, unlike amoxicillin-clavulanate or piperacillin-tazobactam, remained virtually unchanged in ESBL (100%) and non-ESBL (98.8%) E. coli producers. Its activity decreased in ESBL-K. pneumoniae (74.7%) but was higher than that of amoxicillin-clavulanate (14.0%) and piperacillin-tazobactam (24.0%). Interestingly, ertapenem susceptibility was maintained in >60% of ESBL isolates that were resistant to amoxicillin-clavulanate, piperacillin-tazobactam or fluoroquinolones.
Conclusions. SMART-Spain results support current guidelines which include ertapenem as empiric treatment in mild-moderate community-acquired IAI, particularly with ESBL producers. These recommendations will need to be updated with the recently introduction of new antimicrobials.

Rev Esp Quimioter 2018; 31(2): 136-145.  [Full-text PDF]

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Rev Esp Quimioter 2018; 31(2): 110-117

Impact of an antimicrobial stewardship program on urinary tract infections caused by extended-spectrum β-lactamase-producing Escherichia coli

ERIKA ESTEVE-PALAU, SANTIAGO GRAU, SABINA HERRERA, LUISA SORLÍ, MILAGRO MONTERO, CONCHA SEGURA, XAVIER DURÁN, JUAN P. HORCAJADA

Objective.  To analyze the clinical and economic impact of an antimicrobial stewardship program (ASP) targeting urinary tract infections (UTI) caused by extended-spectrum β-lactamase (ESBL)-producing Escherichia coli.
Methods. An observational retrospective study that included adults with a diagnosis of UTI caused by ESBL-producing E. coli admitted to a tertiary care hospital in Barcelona, Spain, between January 2014 and December 2015. The impact of the ASP was analyzed in terms of clinical and economic outcomes.
Results. A total of 222 patients met the inclusion criteria and an intervention was made by the ASP team in 104 cases (47%). ASP intervention was an independent variable related to clinical cure (p = 0.008). Other variables influencing clinical outcomes were the McCabe Jackson score (p = 0.005) and outpatient status (p < 0.001). The ASP interventions in this study had no economic impact.
Conclusion. Antimicrobial stewardship has a positive clinical impact on UTIs caused by ESBL-producing E. coli. Further prospective studies are needed to assess the economic impact of ASPs on UTI caused by ESBL-producing E. coli.

Rev Esp Quimioter 2018; 31(2): 110-117 [Full-text PDF]

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Rev Esp Quimioter 2018; 31(1): 78-100

Antibiotic selection in the treatment of acute invasive infections by Pseudomonas aeruginosa: Guidelines by the Spanish Society of Chemotherapy

JOSÉ MENSA, JOSÉ BARBERÁN, ALEX SORIANO, PEDRO LLINARES, FRANCESC MARCO, RAFAEL CANTÓN, GERMAN BOU, JUAN GONZÁLEZ DEL CASTILLO, EMILIO MASEDA, JOSÉ RAMÓN AZANZA, JUAN PASQUAU, CAROLINA GARCÍA-VIDAL, JOSÉ MARÍA REGUERA, DOLORES SOUSA, JOAQUÍN GÓMEZ, MIGUEL MONTEJO, MARCIO BORGES, ANTONIO TORRES, FRANCISCO ALVAREZ-LERMA, MIGUEL SALAVERT, RAFAEL ZARAGOZA, ANTONIO OLIVER

Pseudomonas aeruginosa is characterized by a notable intrinsic resistance to antibiotics, mainly mediated by the expression of inducible chromosomic β-lactamases and the production of constitutive or inducible efflux pumps. Apart from this intrinsic resistance, P. aeruginosa possess an extraordinary ability to develop resistance to nearly all available antimicrobials through selection of mutations. The progressive increase in resistance rates in P. aeruginosa has led to the emergence of strains which, based on their degree of resistance to common antibiotics, have been defined as multidrug resistant, extended-resistant and panresistant strains. These strains are increasingly disseminated worldwide, progressively complicating the treatment of P. aeruginosa infections. In this scenario, the objective of the present guidelines was to review and update published evidence for the treatment of patients with acute, invasive and severe infections caused by P. aeruginosa. To this end, mechanisms of intrinsic resistance, factors favoring development of resistance during antibiotic exposure, prevalence of resistance in Spain, classical and recently appeared new antibiotics active against P. aeruginosa, pharmacodynamic principles predicting efficacy, clinical experience with monotherapy and combination therapy, and principles for antibiotic treatment were reviewed to elaborate recommendations by the panel of experts for empirical and directed treatment of P. aeruginosa invasive infections.

Rev Esp Quimioter 2017; 31(1): 78-100 [Full-text PDF]


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