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Rev Esp Quimioter 2019; 32(1): 68-72

Antimicrobial activity of ceftolozane-tazobactam against multidrug-resistant and extensively drug-resistant Pseudomonas aeruginosa clinical isolates from a Spanish hospital

ANA ISABEL LÓPEZ-CALLEJA, ELENA MORILLA MORALES, ROSSI NUÑEZ MEDINA, MARTA FERNÁNDEZ ESGUEVA, JUAN SAHAGÚN PAREJA, JUAN MANUEL GARCÍA-LECHUZ MOYA, ISABEL FERRER CERÓN, JESÚS VIÑUELAS BAYON, ANTONIO REZUSTA LÓPEZ

Objectives. Our objective was to evaluate the in vitro activity of ceftolozane-tazobactam against multidrug resistant (MDR) and extensively drug-resistant (XDR) non metallo-β-lactamase producing Pseudomonas aeruginosa clinical isolates at Hospital Universitario Miguel Servet (Zaragoza, Spain) from February 2016 to October 2017.
Material and methods. We evaluated the in vitro activity of ceftolozane-tazobactam and other antipseudomonal antibiotics against 12 MDR and 117 XDR non metallo-β-lactamase producing P. aeruginosa isolates. Ceftolozane-tazobactam minimal inhibitory concentrations (MICs) were determined by MIC gradient diffusion test strip.
Results. Among the 129 MDR/XDR isolates included, 119 (92.2%) were susceptible to ceftolozane-tazobactam, and ten (7.8%) were resistant. MIC50 was 2 mg/L, and MIC90 4 mg/L. Ceftolozane-tazobactam was the second most active antibiotic after colistin, overtaking amikacin.
Conclusions. Ceftolozane-tazobactam is a valuable treatment option for MDR and XDR P. aeruginosa infections in our setting.

Rev Esp Quimioter 2019; 32(1): 68-72  [Full-text PDF]

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Rev Esp Quimioter 2019; 32(1): 60-67

Evolution of the incidence of colonized and infected patients by VIM carbapenemase-producing bacteria in a pediatric hospital in Spain

RAQUEL GONZÁLEZ-RUBIO, DAVID PARRA-BLÁZQUEZ, ISABEL SAN-JUAN-SANZ, GUILLERMO RUIZ-CARRASCOSO, SARA GALLEGO, LUIS ESCOSA-GARCÍA, ANA ROBUSTILLO-RODELA

Introduction. The aim of this study is to describe the evolution of the incidence of infected and colonized patients with carbapenemase VIM-producing bacteria (CPB-VIM) at a national referral pediatric center in Madrid, Spain, between 2012 and 2015.
Material and methods. Descriptive epidemiological surveillance study. The surveillance system included case detection (screening for BPC colonization in all admitted patients, with periodicity according to the ward) and control measures (contact precautions, identification of previously colonized patients at admission, environmental cleaning, education, supervision of contact precautions, and patient cohort). All hospitalized patients with first positive microbiological sample for CPB-VIM in 2012-2015 were included. Colonized patients were followed through clinical history to evaluate later infection.
Results. We found 239 colonized and 51 infected patients with CPB-VIM (49.3% women, 47.6% were 5 months old or younger, 52.1% admitted at Intensive Care Unit). Infection and colonization incidence were, respectively, 2.6 and 6.7 cases per one thousand hospitalized patients in 2012, 1.8 and 10.0 in 2014 and 0.3 and 5.0 in 2015. Within these patients, 84.4% shared ward with other patient with previous positive sample. 13.0% (31/239) of colonized patients had a subsequent infection.
Conclusions. We have shown data of pediatric patients affected by BPC-VIM, collected from an epidemiological surveillance system that included systematic screening at a national referral center. After an epidemic period, the incidence of cases went down. The surveillance and infection control measures intensification, as well as coordination with involved departments, were key in the handling of the situation.

Rev Esp Quimioter 2019; 32(1): 60-67  [Texto completo PDF]

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Rev Esp Quimioter 2019;32(1): 31-39

Strategies for the management of invasive fungal infections due to filamentous fungi in high-risk hemato-oncological patients

CARLOS VALLEJO, JESÚS FORTÚN AND THE STUDY GROUP FOR IFI MANAGEMENT

Introduction. In recent years, the introduction of new antifungals for the prevention of invasive fungal infections (IFIs) in hemato- oncological patients, particularly extended-spectrum azoles, has led to a change in the diagnostic and therapeutic strategies for established or suspected breakthrough IFI. The aim of the study was to identify the diagnostic and therapeutic strategies used in the management of IFIs in hemato-oncological patients in Spain, and to assess compliance with the recommendations of the consensus documents and clinical practice guidelines.
Patients and Methods. An online, anonymous, cross-sectional survey was conducted between January and September 2016 involving 137 specialists from third-level hospitals in Spain with Departments of Hematology that regularly deal with IFIs.
Results. Galactomannan test was available to 95.6% of specialists, and was used in 61.7% of the cases for diagnostic confirmation and early treatment. The (1 → 3) β-D-glucan test was only available to 10.2%. A total of 75.3% of the participants estimated the incidence of breakthrough IFI due to filamentous fungus as being 1-10%. In turn, 83.3% of the participants decided a change in antifungal class after failure of prophylaxis, in concordance with the recommendations of the national and international consensus documents.
Conclusions. The present study, the first of its kind conducted in Spain, shows that a high percentage of the medical professionals implicated in the management of hemato-oncological patients at high risk of suffering IFIs follow the recommendations of the national and international consensus documents and guidelines.

Rev Esp Quimioter 2019;32(1): 31-39  [Full-text PDF]

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Rev Esp Quimioter 2019; 32(1): 50-59

Recommendations from a panel of experts on the usefulness of fidaxomicin for the treatment of infections caused by Clostridium difficile

EMILIO BOUZA, JAVIER COBO, BENITO ALMIRANTE Y EL GRUPO DE TRABAJO CLODIEXPAN

Introduction. Clostridium difficile infections have a high recurrence rate, which can complicate the prognosis of affected patients. It is therefore important to establish an early detection and an appropriate therapeutic strategy. The objective of this manuscript was to gather the opinion of an expert group about the predictive factors of poor progression, as well as when to use fidaxomicin in different groups of high-risk patients.
Methods. A scientific committee of three experts in infectious diseases reviewed the most recent literature on the management of C. difficile infections, and the use of fidaxomicin. They developed a questionnaire of 23 items for consensus by 15 specialists in this type of infection using a modified Delphi method.
Results. The consensus reached by the panelists was 91.3% in terms of agreement. The most important agreements were: recurrence is a risk criterion per se; fidaxomicin is effective and safe for the treatment of infections caused by C. difficile in critical patients, immunosuppressed patients, or patients with chronic renal failure; fidaxomicin is recommended from the first episode of infection to ensure maximum efficacy in patients with well-contrasted recurrence risk factors.
Conclusions. The experts consulted showed a high degree of agreement on topics related to the selection of patients with poorer prognosis, as well as on the use of fidaxomicin in groups of high-risk patients, either in the first line or in situations of recurrence.

Rev Esp Quimioter 2019; 32(1): 50-59  [Texto completo PDF]

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Rev Esp Quimioter 2019; 32(1): 6-14

Impact of empirical treatment with antifungal agents on survival of patients with candidemia

RODRIGO POVES-ALVAREZ, BEATRIZ CANO-HERNÁNDEZ, MARÍA FE MUÑOZ-MORENO, SARA BALBÁS-ALVAREZ, PATRICIA ROMÁN-GARCÍA, ESTHER GÓMEZ-SÁNCHEZ, BEATRIZ MARTÍNEZ-RAFAEL, ESTEFANÍA GÓMEZ-PESQUERA, MARIO LORENZO-LÓPEZ, ELISA ALVAREZ-FUENTE, OLGA DE LA VARGA, MIGUEL FLORES, JOSÉ MARÍA EIROS, EDUARDOTAMAYO, MARÍA HEREDIA-RODRÍGUEZ

Introduction. The objective of this study was to evaluate the impact of echinocandins and fluconazole) on mortality 7 and 30 days after candidemia onset and overall in-hospital mortality), in patients with candidemia at a Spanish tertiary hospital.
Methods. A retrospective study was conducted that enrolled all non-neutropenic adult patients diagnosed with candidemia at Hospital Clínico Universitario de Valladolid between 2007 and 2016. A total of 179 patients were evaluated, they were divided into two sub-groups: surviving patients (n = 92) and non-surviving patients (n = 87).
Results. The 7-day mortality was 25,1% (45), 30-day mortality was 46,9% (84), and overall in-hospital mortality was 48,6% (87). 40.8% of patients received no antifungal treatment (43.8% of surviving patients and 37.8% of non-surviving patients; p=0.15). A total of 106 (59.2%) patients were treated, of which 90 patients (50.3%) received empiric treatment. 19.6% and 47.8% of surviving patients were treated with echinocandins and fluconazole, respectively. By contrast, of non-surviving patients, 31.0% were treated with echinocandins and 47.1% received fluconazole. Survival for the first 7 days was significantly higher in treated with antifungal agents (log-rank = 0.029), however, there were not significant differences in 30-day survival. Factors linked to a significant increase in overall in-hospital mortality were age (OR 1.040), septic shock (OR 2.694) and need for mechanical ventilation > 48 h (OR 2.812).
Conclusion. Patients who received antifungal treatment, regardless of whether they received fluconazole or echinocandins, had a significantly lower mortality rate after 7 days than untreated patients, although no significant differences in 30-day mortality were seen.

Rev Esp Quimioter 2019; 32(1): 6-14  [Full-text PDF]

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