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Rev Esp Quimioter 2022; 35(6):519-537

Unresolved issues in the epidemiology and diagnosis of bacteremia: an opinion paper

DAVID ALONSO-MENCHÉN, PATRICIA MUÑOZ, CARLOS SÁNCHEZ-CARRILLO, LEIRE PÉREZ-LATORRE, EMILIO BOUZA

Published: 28 July 2022

http://www.doi.org/10.37201/req/066.2022

Bacteremia is an important cause of morbidity and mortality worldwide and, despite the diagnostic and therapeutic advances of the last decades, the evidence supporting many diagnostic aspects of bacteremia is scarce. Information on the epidemiological evolution of this entity is limited and many methodological aspects of blood culture collection and analysis are under discussion. Furthermore, the recommendations of the main scientific societies on many of these aspects are variable and, in many cases, have not been updated recently.
In this scenario, we have arranged a series of questions on different aspects of bacteremia and reviewed the literature trying to find proper answers for them. We offer our opinion on the topics where the evidence was weak.
The topics covered include epidemiological aspects of bacteremia, indications for blood culture extraction, methods for obtaining and incubating samples, or ways of transmitting results from the microbiology laboratory.
We do not intend to summarize the current clinical practice guidelines, nor will we deal with the therapeutic management of this entity. The aim of this paper is to review the current perspective on the diagnosis of bacteremia with a critical approach, to point out the gaps in the literature, to offer the opinion of a team dedicated to infectious diseases and clinical microbiology, and to identify some areas of knowledge on which future studies should focus.

Rev Esp Quimioter 2022; 35(6):519-537 [Full-text PDF]


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Rev Esp Quimioter 2022; 35(5):468-474

Impact of Staphylococcus aureus bacteremia in COVID-19 patients

MARIA ESPINOSA PEREZ, ROSA GARCÍA FENOLL, SARAY MORMENEO BAYO, ROSA MARÍA MARTÍNEZ ÁLVAREZ, VIOLETA FRUTOS MILLÁN, MARÍA CRUZ VILLUENDAS USÓN, MARÍA PILAR PALACIÁN RUIZ, JOSÉ MIGUEL ARBONÉS MAINAR, MARÍA CARMEN MARTÍNEZ JIMÉNEZ, CARLOS RAMOS PAESA

Published: 22 July 2022

http://www.doi.org/10.37201/req/022.2022

Introduction. The disease caused by SARS-CoV-2 (COVID-19) has been a challenge for healthcare professionals since its appearance. Staphylococcus aureus has been described as one of the main pathogens causing bacterial infections in viral pandemics. However, co- infection with S. aureus causing bacteremia in patients with COVID-19 has yet to be well studied.
Methods. We performed a e study of S. aureus bacteremia (SAB) at Hospital Miguel Servet (Zaragoza) from March 2020 to February 2021. The clinical characteristics, mortality and risk factors of adults hospitalized patients with BSA associated COVID-19 compared to patients without COVID-19.
Results. A total of 95 patients with SAB were identified. 27.3% were positive for SARS-CoV-2. SAB represented 9.9% of bacteremia, being the second agent in frequency after E. coli. Nosocomial bacteremia was more frequent in the group of COVID-19 patients. The most frequent source of BSA in these patients was the respiratory source (26.9% vs 0%; P<0.001) followed by the skin (15.5% vs 15.9%; P=1). The development of sepsis was more frequent in COVID-19 patients (61,5% vs 7,8%; P=0,336) and among them, who received dexamethasone at doses > 6 mg/day (62.5% vs. 37.5%, P<0.05).
Conclusions. Our data suggest that BSA has a negative impact on the evolution of patients with COVID-19. However, further and preferably prospective studies are required to obtain solid data on the impact of BSA on coronavirus patients.

Rev Esp Quimioter 2022; 35(5):468-474 [Texto completo PDF]


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Rev Esp Quimioter 2022; 35(5):455-467

A systematic literature review and expert consensus on risk factors associated to infection progression in adult patients with respiratory tract or rectal colonisation by carbapenem-resistant Gram-negative bacteria

RICARD FERRER, ALEX SORIANO, RAFAEL CANTÓN, JOSÉ LUIS DEL POZO, CAROLINA GARCÍA-VIDAL, JOSÉ GARNACHO-MONTERO, NIEVES LARROSA, PEDRO RASCADO, MIGUEL SALAVERT, VICENTE PINTADO, ARIADNA GIRÓ-PERAFITA, XAVIER BADIA

Published: 21 July 2022

http://www.doi.org/10.37201/req/062.2022

Objective. Risk factors (RFs) associated with infection progression in patients already colonised by carbapenem-resistant Gram-negative bacteria (CRGNB) have been addressed in few and disperse works. The aim of this study is to identify the relevant RFs associated to infection progression in patients with respiratory tract or rectal colonisation.
Material and methods. A systematic literature review was developed to identify RFs associated with infection
progression in patients with CRGNB respiratory tract or rectal colonisation. Identified RFs were then evaluated and discussed by the expert panel to identify those that are relevant according to the evidence and expert’s experience.
Results. A total of 8 articles were included for the CRGNB respiratory tract colonisation and 21 for CRGNB rectal colonisation, identifying 19 RFs associated with pneumonia development and 44 RFs associated with infection progression, respectively. After discussion, the experts agreed on 13 RFs to be associated with pneumonia development after respiratory tract CRGNB colonisation and 33 RFs to be associated with infection progression after rectal CRGNB colonisation. Respiratory tract and rectal colonisation, previous stay in the ICU and longer stay in the ICU were classified as relevant RF independently of the pathogen and site of colonisation. Previous exposure to antibiotic therapy or previous carbapenem use were also common relevant RF for patients with CRGNB respiratory tract and rectal colonisation.
Conclusion. The results of this study may contribute to the early identification of CRGNB colonized patients at higher risk of infection development, favouring time-to-effective therapy and improving health outcomes.

Rev Esp Quimioter 2022; 35(5):455-467 [Full-text PDF] [Supplementary material PDF]


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Rev Esp Quimioter 2022; 35(5):498-499

Osteomielitis polimicrobiana en extremidad de la mano tras mordedura de gato

PABLO CAMACHO ZAMORA, MERCEDES ROMÁN CABELLO, PATRICIA ÁLVAREZ GARCÍA, ESTHER VÁZQUEZ CANAL

Published: 20 July 2022

LETTER TO THE EDITOR

http://www.doi.org/10.37201/req/009.2022

Rev Esp Quimioter 2022; 35(5):498-499  [Texto completo PDF]


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Rev Esp Quimioter 2022; 35(5):500-502

Congenital tuberculosis in a premature newborn

LAURA SOLAZ ESCRIG, MANUEL BELDA ÁLVAREZ, RAQUEL SORIA MARTIN, AARON ROMUALDO PUPLÀ BARTOLL, MA DOLORES TIRADO BALAGUER

Published: 19 July 2022

LETTER TO THE EDITOR

http://www.doi.org/10.37201/req/018.2022

Rev Esp Quimioter 2022; 35(5):500-502  [Full-text PDF]

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Rev Esp Quimioter 2022; 35(5):506-507

Osteomielitis del cuboides por Mycobacterium smegmatis  

ANA RUIZ-CASTILLO, ALBERTO TENORIO-ABREU, ALICIA HIDALGO-JIMÉNEZ, JOSÉ MARÍA SAAVEDRA-MARTÍN

Published: 18 July 2022

LETTER TO THE EDITOR

http://www.doi.org/10.37201/req/049.2022

Rev Esp Quimioter 2022; 35(5):506-507  [Texto completo PDF]


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Rev Esp Quimioter 2022; 35(5):482-491

Congenital cytomegalovirus infection, is more prevalent in our country in newborns exposed to HIV?

JORGE BUSTAMANTE-AMADOR, ISABEL MELLADO-SOLA, MARÍA PILAR ROMERO-GÓMEZ, MARTA CABRERA-LAFUENTE, MARÍA DE LA CALLE-FERNÁNDEZ-MIRANDA, TALÍA SAINZ-COSTA, MARÍA JOSÉ MELLADO-PEÑA, LUIS ESCOSA-GARCÍA, EN REPRESENTACIÓN DEL GRUPO DE TRABAJO SOBRE INFECCIÓN PERINATAL-NEONATOLOGÍA-GINECOLOGÍA (GINPER)

Published: 18 July 2022

http://www.doi.org/10.37201/req/037.2022

Objectives. Congenital cytomegalovirus infection (cCMV) has been considered more prevalent among HIV-exposed children during pregnancy. Spanish national guidelines recommend the cCMV screening in these newborns. Nowadays, pregnant women have a better control of HIV infection compared to previous decades. We aim to analyze the prevalence and associated risk factors to cCMV in these children.
Patients and methods. A retrospective cross-sectorial study was performed. All newborns exposed to HIV were assisted in a third-level hospital (2014-2020). Epidemiological and clinical data of the mother and newborn were recorded. Shell vial urine culture and/or CRP were performed along the two first weeks of life for the neonatal screening of cCMV.
Results. Overall 69 newborns were enrolled. A high proportion (82.4%) of the mothers had been diagnosed with HIV before getting pregnant. All women received ART during the pregnancy. Median T-CD4 lymphocytes before delivery was 641/mm3 (IQR: 480-865) and the viral load was undetectable in 83.6%. Serological test for CMV along the first trimester of pregnancy was performed in 73.5% (positive IgG in 96%). There were no congenital cases of HIV neither cCMV (CI 95%:0-5.3%).
Conclusions. The cCMV prevalence in newborns exposed to HIV was 0%, lower than reported before, probably related to a better and earlier ART during pregnancy, leading to a better immunological status.

Rev Esp Quimioter 2022; 35(5):482-491 [Texto completo PDF]


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Rev Esp Quimioter 2022; 35(4):357-361

Interactions listed in the Paxlovid fact sheet, classified according to risks, pharmacological groups, and consequences

JOSÉ RAMÓN AZANZA, JOSEP MENSA, JUAN GONZÁLEZ DEL CASTILLO, MANUEL LINARES RUFO, JOSÉ MARÍA MOLERO, NATALIA MADERO VALLE, JOSÉ BARBERÁN

Published: 13 July 2022

http://www.doi.org/10.37201/req/054.2022

Paxlovid (nirmatrelvir plus ritonavir) is a new oral antiviral therapeutic for the treatment of COVID-19. Nirmatrelvir is an inhibitor of SARS-CoV-2 main protease, while ritonavir is used as a CYP3A inhibitor in low doses to slow the metabolism of nirmatrelvir, thus enhancing their therapeutic effect. The isoenzyme CYP3A4 is responsible for at least part of the oxidative metabolism of approximately 60% of available medications and ritonavir is therefore a significant source of drug interactions. We describe here the drugs that are contraindicated or should be used with or without precautions when Paxlovid (nirmaltrevir plus ritonavir) should be administered according to each fact sheet in force at the Spanish Agency for Medicines and Health Products.

Rev Esp Quimioter 2022; 35(4):357-361 [Full-text PDF]


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Rev Esp Quimioter 2022; 35(5):503-505

Two rare cases of pleural infection due to Prevotella species  

FERNANDO COBO, ANA LARA-OYA, IGNACIO CORREA, ENRIQUE RODRÍGUEZ-GUERRERO, VIRGINIA PÉREZ-CARRASCO, JOSÉ A. GARCÍA-SALCEDO, JOSÉ MARÍA NAVARRO-MARÍ

Published: 14 July 2022

LETTER TO THE EDITOR

http://www.doi.org/10.37201/req/046.2022

Rev Esp Quimioter 2022; 35(5):503-505  [Full-text PDF]


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Rev Esp Quimioter 2022; 35(5):492-497

The postal code as a “bar code” of antimicrobial resistance

PILAR GALICIA, MANUEL LINARES, ÁNGEL MIGUEL-BENITO, FELIPE PÉREZ GARCÍA, MIGUEL GÓRGOLAS, JOSÉ-MANUEL RAMOS-RINCÓN, JUAN CUADROS

Published: 13 July 2022

http://www.doi.org/10.37201/req/021.2022

Introduction. The need to integrate local resistances into clinical practice is increasingly urgent, especially in Primary Care where empirical treatment is frequent.
Methods. A retrospective observational study of positive microbiological isolates of Neisseria gonorrhoeae from any location (urethral, cervical, pharyngeal, rectal or urine) was carried out in the health area of Alcalá de Henares. Sociodemographic characteristics and resistance to cephalosporins, azithromycin, penicillin and quinolones were analyzed. Each isolate was related to its postal code of origin.
Results. We analyzed 256 microbiological samples of N.gonorrhoeae, most of them male (92.9%) with a mean age of 33 years. Half of the samples (49.8%) were resistant to ciprofloxacin. Temporal and spatial evolution of antimicrobial resistance was integrated in heat maps.
Conclusion. Knowing local resistances can help to prescribe more adequate empirical treatments, especially in Primary Care, avoiding inadequate antibiotics and decreasing resistance rates.

Rev Esp Quimioter 2022; 35(5):492-497 [Texto completo PDF]


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