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Rev Esp Quimioter 2024, February 19

Antibiotic stewardship programs in the Spanish emergency services: PROA-URG Study

JESÚS RUIZ RAMOS, ANA SUÁREZ-LLEDÓ GRANDE, MARÍA ROSARIO SANTOLAYA PERRÍN, CARMEN CABALLERO REQUEJO, MARIAM HIJAZI VEGA, LAIA LÓPEZ VINARDELL, ÁNGELES GARCÍA MARTÍN, YLENIA CAMPOS BAETA, ANA JOSEFA MARCOS GONZÁLEZ, MONTSERRAT ALONSO DÍEZ, SILVIA CONDE GINER, SAÚL HERRERA CARRANZA, ANA SUCH DIÁZ, MARGARITA PRATS RIERA, LARA MENENDEZ LIENDO, CRISTINA TORO BLANCH, ANA REVUELTA AMALLO, CRISTINA CALZÓN BLANCO, EN REPRESENTACIÓN DEL GRUPO PROA-URGENCIAS

Published: 19 February 2024

http://www.doi.org/10.37201/req/138.2023

Introduction. Antimicrobial stewardship programs (ASP) have become a key tool in the adaptation of these drugs to the health system. The information available on the application and indicators used in these programs in emergency departments is scarce. The objective of this study is to know the extent of ASP implementation in the emergency departments, as well as the use of antimicrobials in these units.
Material and methods. Multicenter retrospective study. An invitation was sent to all participants of the REDFASTER-SEFH emergency pharmacist working group. A questionnaire was used consisting of 21 items, answered by a team made up of a pharmacist, emergency room specialist, infectious disease specialist and microbiologist.
Results. Eighteen hospitals completed the survey. Fourteen (77.8%) had an ASP manager. The DDD value per 1000 admissions ranged between 36.5 and 400.5 (median: 100.4 [IQR:57.2-157.3]). Both carbapenem and macrolide group presented wide variability in use. Six (33.3%) hospitals had an annual report on the specific resistance profile for urine and blood cultures. The percentage of multi-drug resistant strains in urine cultures was 12.5% and in blood cultures 12.2%. The percentage of adequacy in the bacteremia treatment was 81.0% (IQR:74.6-85.0%), while in urinary tract infections was 78.0% (IQR:71.5-88.0).
Conclusions. Despite the existence of ASP members in emergency services, as well as the training activity and local guidelines is common. knowledge of the use of antimicrobials and resistances is limited. Future activities must be aimed at improving information about the ASP results in these units.

Rev Esp Quimioter 2024; February 19 [Texto completo PDF]


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Rev Esp Quimioter 2024;37(1): 88-92

Rapid AST: Possibility of inferring resistance mechanisms with complex phenotypes

JORGE LIGERO-LÓPEZ, IKER FALCES-ROMERO, ALFONSO ARANDA-DÍAZ, DIANA GARCÍA-BALLESTEROS, JULIO GARCÍA-RODRÍGUEZ, EMILIO CENDEJAS-BUENO

Published: 8 November 2023

http://www.doi.org/10.37201/req/043.2023

The new automated systems designed for rapid performance of AST have significantly reduced the response time for susceptibility testing of microorganisms causing bacteremia and sepsis. The Accelerate Pheno® system (AAC) is one such system. Our objective for this study was to determine whether the AAC system is capable of providing an accurate susceptibility profile to infer resistance mechanisms in different carbapenemase-producing isolates when compared to the MicroScan WalkAway System (MWS). Disk diffusion method was also performed on all isolates as a reference method. Additionally, we compared the results obtained with the routine AST production system. We selected 19 isolates from the cryobank of the Microbiology department, all of which were carbapenemase-producing gram-negative bacilli. AAC was able to identify and infer the resistance of a total of 10 isolates, with an EA and CA of 84.2% for meropenem and 88.2% and 64.7% for ertapenem EA and CA, respectively. If we consider the disk diffusion technique, the CA was 57.9% and 76.5% for meropenem and ertapenem. However, in the presence of carbapenemases, AAC was not able to provide adequate MICs or infer the resistance mechanisms of the isolates accurately. Further studies with a larger number of isolates, including the new antibiotics ceftolozane/tazobactam and ceftazidime/avibactam, are needed for a more comprehensive comparison.

Rev Esp Quimioter 2024;37(1): 88-92 [Full-text PDF]


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Rev Esp Quimioter 2024 January 23

Is it in their eyes? Correlation between microorganisms isolated from bronchial aspirates and conjunctival swabs in a Pediatric Intensive Care Unit

JORGE LIGERO-LÓPEZ, LUIS ESCOSA-GARCÍA, CRISTINA SCHÜFFELMANN-GUTIÉRREZ, MARÍA LAPLAZA-GONZÁLEZ, MARÍA INMACULADA QUILES-MELERO, FRANCISCO MORENO-RAMOS, FERNANDO BAQUERO-ARTIGAO, JUANA CACHO-CALVO, EMILIO CENDEJAS-BUENO

Published: 23 January 2024

http://www.doi.org/10.37201/req/116.2023

Objectives. Our observational, retrospective study aimed to determine the correlation between bacteria isolated from bronchial aspirates of pediatric ICU patients (PICU) with respiratory infections and those obtained from conjunctival swabs of the same patients exhibiting clinical conjunctivitis.
Material and methods. Throughout the period from 2015 to 2022, we reviewed all clinically significant bronchial aspirates (≥105 CFU/mL) and positive conjunctival swabs obtained from PICU patients. These records were retrieved from the microbiology database, cross-referencing the data to identify patients who tested positive for both during the same clinical episode.
Results. The median age of the patients was 5 months (interquartile range: 1-7). Among the cohort, twenty-one patients exhibited positivity in both bronchial aspirate and conjunctival swab samples, showcasing a microbial match in 85.71% of cases (18 out of 21). The most frequently isolated microorganisms were Haemophilus influenzae (55.6%), followed by Pseudomonas aeruginosa (14.3%), Klebsiella aerogenes (9.5%), and Escherichia coli, Stenotrophomonas maltophilia, and Enterobacter cloacae, each accounting for 4.8% of the isolates.
Conclusions. Our study demonstrates a strong concordance between the isolated microorganisms from both samples in patients presenting clear symptoms of clinical conjunctivitis. These findings provide a basis for future prospective studies that may leverage conjunctival swabs as a predictive tool for identifying microorganisms involved in respiratory infections.

Rev Esp Quimioter 2024; January 23 [Full-text PDF]


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Rev Esp Quimioter 2024 January 22

Prevalence and risk factors for methicillin-resistant Staphylococcus aureus infection in children

PAULA MARÍN OLIVÁN, SUSANA FERRANDO MONLEÓN, JOSÉ RAFAEL BRETÓN-MARTÍNEZ, ANDRÉS PIOLATTI LUNA, IDOIA HERNÁNDEZ MONLEÓN, CRISTINA FUERTES LATASA, DAVID NAVARRO ORTEGA, JAVIER COLOMINA RODRÍGUEZ

Published: 22 January 2024

http://www.doi.org/10.37201/req/113.2023

Introduction. The objectives of this work were to know the prevalence of methicillin-resistant S. aureus (MRSA) infections in the paediatric population of our health department, to describe the risk factors for infection by MRSA compared to those produced by methicillin-susceptible S. aureus (MSSA) and to know the antibiotic sensitivity profile of MRSA and MSSA isolates.
Material and methods. A retrospective, descriptive and analytical study of infections produced by MRSA versus those produced by MSSA was carried out during the years 2014 to 2018. Risk factors for MRSA infection were studied using a binary logistic regression model.
Results. 162 patients with S. aureus infections were identified. Of these, 25 (15.4%) were MRSA. The highest percentages of MRSA infection occurred among children who required hospital admission (23.4%). In the univariate analysis the need of hospital admission, antibiotic treatment in the last 3 months, the kind of infection and past MRSA infection or colonisation reached statistical significance. However, only the need of hospital admission and antibiotic treatment in the last 3 months maintained statistical significance in the binary logistic regression model. Correct antibiotic treatment was only prescribed in 26.7% of the MRSA infection cases admitted to the hospital.
Conclusions. Our results suggest the need to review empirical local treatment regimen using drugs active against MRSA in infections of probable staphylococcal origin admitted to the hospital, especially if they have received antibiotic treatment in the last 3 months.

Rev Esp Quimioter 2024; January 22 [Texto completo PDF]


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Rev Esp Quimioter 2024 January 19

Comparison of quality of life in patients living with HIV infection through pharmaceutical care according to CMO methodology vs. conventional follow-up. MAS-VIH project

JOSÉ MANUEL MARTÍNEZ SESMERO, LUIS MARGUSINO FRAMIÑAN, MERCEDES GIMENO GRACIA, VERA ÁREAS DEL ÁGUILA, HERMINIA NAVARRO AZNARES, MARÍA JOSÉ HUERTAS FERNÁNDEZ, EMILIO MOLINA CUADRADO, PILAR DÍAZ RUIZ, MARÍA TERESA MARTIN CONDE, ELENA ALONSO GRANDES, ALICIA LÁZARO LÓPEZ, RAMÓN MORILLO VERDUGO

Published: 19 January 2024

http://www.doi.org/10.37201/req/105.2023

Objective. To compare quality of life, in patients living with HIV infection with pharmaceutical care according to the CMO methodology: capacity, motivation and opportunity versus conventional follow-up.
Method. Longitudinal, prospective, multicenter, health intervention study, conducted between October 2019 and November 2021 in 14 centers throughout Spain. Patients over 18 years of age, receiving antiretroviral treatment and attending the consultations of the participating Pharmacy Services for 1 year were included. Patients who did not have the autonomy to complete the planned questionnaires were excluded. At baseline, participating centers were randomized to continue using the same systematics of work (traditional follow-up) or to implement the CMO model using patient stratification models, goal setting in relation to pharmacotherapy, use of motivational interviewing, as well as longitudinal follow-up enabled by new technologies. The main variable was the difference in the number of dimensions positively affected in each follow-up arm at 24 weeks of follow-up according to the MOS-HIV questionnaire. In the CMO group, the interventions performed the most frequently were recorded.
Results. 151 patients were included. The median age was 51.35 years. A significant improvement in quality of life was found at the end of follow-up in the CMO group, reducing the number of patients with negatively affected dimensions (2/11 vs 8/11). The most frequent interventions carried out in the CMO group, according to the taxonomy, were Motivation (51,7%) and review and validation (49,4%).
Conclusions. The quality of life of patients is higher in those centers that develop Pharmaceutical Care based on the CMO methodology compared to traditional follow-up.

Rev Esp Quimioter 2024; January 19 [Texto completo PDF]


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Rev Esp Quimioter 2024 January 16

Efficacy of delafloxacin alone and in combination with cefotaxime against cefotaxime non-susceptible invasive isolates of Streptococcus pneumoniae

ESTHER RÍOS, MARTA PÉREZ, JUAN CARLOS SANZ, ALBERTO DELGADO-IRIBARREN, ICIAR RODRÍGUEZ-AVIAL

Published: 16 January 2024

http://www.doi.org/10.37201/req/107.2023

Objectives. We assessed the in vitro activity of delafloxacin and the synergy between cefotaxime and delafloxacin among cefotaxime non-susceptible invasive isolates of Streptococcus pneumoniae (CNSSP).
Material and methods. A total of 30 CNSSP (cefotaxime MIC > 0.5 mg/L) were studied. Serotyping was performed by the Pneumotest-Latex and Quellung reaction. Minimum inhibitory concentrations (MICs) of delafloxacin, levofloxacin, penicillin, cefotaxime, erythromycin and vancomycin were determined by gradient diffusion strips (GDS). Synergistic activity of delafloxacin plus cefotaxime against clinical S. pneumoniae isolates was evaluated by the GDS cross method.
Results. Delafloxacin showed a higher pneumococcal activity than its comparator levofloxacin (MIC50, 0.004 versus 0.75 mg/L and MIC90, 0.047 versus >32 mg/L). Resistance to delafloxacin was identified in 7/30 (23.3%) isolates, belonging to serotypes 14 and 9V. Synergy between delafloxacin and cefotaxime was detected in 2 strains (serotypes 19A and 9V). Antagonism was not observed. Addition of delafloxacin increased the activity of cefotaxime in all isolates. Delafloxacin susceptibility was restored in 5/7 (71.4%) strains.
Conclusions. CNSSP showed a susceptibility to delafloxacin of 76.7%. Synergistic interactions between delafloxacin and cefotaxime were observed in vitro among CNSSP by GDS cross method.

Rev Esp Quimioter 2024; January 16 [Full-text PDF]


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Rev Esp Quimioter 2024 January 11

Respiratory syncytial virus: A new era

JULIÁN RUIZ-GALIANA, RAFAEL CANTÓN, PILAR DE LUCAS RAMOS, ALEJANDRA GARCÍA-BOTELLA, ALBERTO GARCÍA-LLEDÓ, TERESA HERNÁNDEZ-SAMPELAYO, JAVIER GÓMEZ-PAVÓN, JUAN GONZÁLEZ DEL CASTILLO, MARI CRUZ MARTÍN-DELGADO, FRANCISCO JAVIER MARTÍN SÁNCHEZ, MANUEL MARTÍNEZ-SELLÉS, JOSÉ MARÍA MOLERO GARCÍA, SANTIAGO MORENO GUILLÉN, FERNANDO RODRÍGUEZ-ARTALEJO, ROSA RODRÍGUEZ FERNANDEZ, MARTA KESTLER, EMILIO BOUZA

Published: 11 January 2024

http://www.doi.org/10.37201/req/147.2023

Respiratory syncytial virus (RSV) is a major public health problem that has undergone significant changes in recent years. First of all, it has become easier to diagnose with highly reliable and rapidly available confirmatory tests. This has led to a better understanding of its epidemiology and RSV has gone from being a disease of the pediatric age group, severe only in infants and immunosuppressed children, to being a common disease in people of all ages, particularly important in patients of advanced age or with immunosuppressive diseases. Recent therapeutic and prophylactic advances, both with long-lasting monoclonal antibodies and vaccines, are another reason for satisfaction. For these reasons, the COVID and Emerging Pathogens Committee of the Illustrious Official College of Physicians of Madrid (ICOMEM) has considered it pertinent to review this subject in the light of new knowledge and new resources for dealing with this infection. We have formulated a series of questions that we believe will be of interest not only to members of the College but also to any non-expert in this subject, with a particular focus on the situation of RSV infection in Spain.

Rev Esp Quimioter 2024; January 11 [Full-text PDF]


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Rev Esp Quimioter 2024 January 11

Importance of National Influenza Centers in the surveillance of highly pathogenic avian viruses. The time for One-Health is now

IVÁN SANZ-MUÑOZ, JOSÉ M EIROS, MARTA HERNÁNDEZ

Published: 11 January 2024

http://www.doi.org/10.37201/req/137.2023

Since 1996, the highly pathogenic avian influenza subtype A(H5N1) has been causing almost uninterrupted outbreaks in wild and domestic birds, as well as cases in humans with a mortality rate close to 50%. However, the years of greatest circulation have been precisely the years following the COVID-19 pandemic, in which several cases have been recorded in humans in places where they had never appeared before, in addition to multiple cases in wild, domestic and peri-domestic mammals, which raise some concern about the risk that the virus may jump to humans through chains of transmission of greater or lesser extent. The current outbreak of A(H5N1) shows us that the One-Health concept should be more alive than ever to join efforts between professionals from different sectors of human, animal and environmental health to avoid or minimize these risks, so that reference laboratories such as the National Influenza Centers have the human and material resources to provide rapid and relevant information in the shortest possible time before emergencies of this type. The diagnostic and monitoring tools to be used in these cases must be available for any eventuality, and going beyond the basic data must be an indispensable premise to be able to carry out a detailed monitoring that serves to limit outbreaks, limit the spread of the disease, and help in the design of future pandemic vaccines against avian viruses.

Rev Esp Quimioter 2024; January 11 [Texto completo PDF]


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