Rev Esp Quimioter 2013:26(1):6-11

Malaria diagnosis and treatment: analyse of a cohort of hospitalised patients at a tertiary level hospital (1998-2010)                                 
 

M. A. IBORRA, E. GARCÍA, B. CARRILERO, M. SEGOVIA               

Introduction. The increasing frequency of malaria infection in our area is due to the rise in international travel and immigration from endemic malaria areas. The aim of this study is to describe the chemoprophylaxis taken and treatment given as well as the clinical, epidemiological and microbiological characteristics for those patients admitted to our hospital with malaria.
Methods. A retrospective study of patients with malaria admitted to the Hospital Virgen de la Arrixaca, between January 1998 and December 2010, was carried out.
Results. During this period, fifty one cases of malaria were diagnosed. 78.3% of them were immigrants of whom 65% resided in Spain and had travelled to their country of origin for a short stay. Seventy four per cent acquired the infection in central and west Africa, and Plasmodium falciparum was responsible for the majority of the cases (88%). Only four patients had taken antimalarial chemoprophylaxis but none correctly.
The most frequently treatment used was a combination of quinine and doxycicline (64.7%). Inappropriate anti-malarial treatment occurred in 9 patients (17.6%). At least one indicator of severe malaria was established in 23.5% of the cases; however, the clinical outcome was successful in every case and no patient died.
Conclusions. Imported malaria is observed mostly among immigrants who travel to their countries of origin for a short stay and do not take anti-malarial prophylaxis, increasing the risk of acquiring malaria. Inappropriate malarial treatment is relatively frequent in the case management of imported malaria.

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Rev Esp Quimioter 2013:26(1):12-20

Physicians with access to point-of-care tests significantly reduce the antibiotic prescription for common cold                                 
 

C. LLOR, S. HERNÁNDEZ, J. M. COTS, L. BJERRUM, B. GONZÁLEZ, G. GARCÍA, J. D. ALCÁNTARA, G.  GUERRA, M. CID, M. GÓMEZ, J. ORTEGA, C. PÉREZ, J. ARRANZ, M. J. MONEDERO, J. PAREDES, V. PINEDA, GRUPO DE TRABAJO HAPPY AUDIT ESPAÑA               

Objective. This study was aimed at evaluating the effect of two levels of intervention on the antibiotic prescribing in patients with common cold.
Methods. Before and after audit-based study carried out in primary healthcare centres in Spain. General practitioners registered all the episodes of common cold during 15 working days in January and February in 2008 (preintervention). Two types of intervention were considered: full intervention, consisting in individual feedback based on results from the first registry, courses in rational antibiotic prescribing, guidelines, patient information leaflets, workshops on rapid tests –rapid antigen detection and C-reactive protein tests– and provision of these tests in the surgeries; and partial intervention, consisting of all the above intervention except for the workshop and they did not have access to rapid tests. The same registry was repeated in 2009 (postintervention). In addition, new physicians filled out only the registry in 2009 (control group).
Results. 210 physicians underwent the full intervention, 71 the partial intervention and 59 were assigned to the control group. The 340 doctors prescribed antibiotics in 274 episodes of a total of 12,373 cases registered (2.2%).The greatest percentage of antibiotic prescription was found in the control group (4.6%). The partial intervention increased the antibiotic prescription percentage from 1.1% to 2.7% while only doctors who underwent the complete intervention lead to a significant reduction of antibiotics prescribed, from 2.9% before to 0.7% after the intervention (p<0.001).
Conclusion. Only physicians with access to rapid tests significantly reduced antibiotic prescription in patients with common cold.

Rev Esp Quimioter 2013:26(1):12-20 [pdf]

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Rev Esp Quimioter 2013:26(1):21-29

Morbidity and mortality associated with primary and catheter-related bloodstream infections in critically ill patients                                  
 

P. M. OLAECHEA, M. PALOMAR,  F. ÁLVAREZ-LERMA,  J. J. OTAL,  J. INSAUSTI,  M. J. LÓPEZ-PUEYO Y EL GRUPO ENVIN-HELICS                

Purpose. To analyze the impact of primary and catheter related bloodstream infections (PBSI/CRBSI) on morbidity and mortality.
Methods. A matched case-control study (1:4) was carried out on a Spanish epidemiological database of critically ill patients (ENVIN-HELICS). To determine the risk of death in patients with PBSI/CRBSI a matched Cox proportional hazard regression analysis was performed.
Results. Out of the 74,585 registered patients, those with at least one episode of monomicrobial PBSI/CRBSI were selected and paired with patients without PBSI/CRBSI for demographic and diagnostic criteria and seriousness of their condition on admission to the Intensive Care Unit (ICU). For mortality analysis, 1,879 patients with PBSI/CRBSI were paired with 7,516 controls. The crude death rate in the ICU was 28.1% among the cases and 18.7% among the controls. Attributable mortality 9.4% (HR:1.20; 95% confidence interval: 1.07–1.34; p<0.001). Risk of death varied according to the source of infection, aetiology, moment of onset of bloodstream infection and severity on admission to the ICU. The median stay in the ICU of patients who survived PBSI/CRBSI was 13 days longer than the controls, also varying according to aetiology, moment of onset of bloodstream infection and severity on admission.
Conclusions. Acquisition of PBSI/CRBSI in critically ill patients significantly increases mortality and length of ICU stay, which justifies prevention efforts.de prevención.

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Rev Esp Quimioter 2013:26(1):30-33

Pyelonephritis in pregnancy. How adequate is empirical treatment?                                  
 

A. ARTERO, J. ALBEROLA, J.M. EIROS,  J.M. NOGUEIRA, A. CANO                 

Objective. To ascertain the adequacy of empirical antimicrobial treatment in pregnant women with acute pyelonephritis.
Material and methods. We have conducted a retrospective observational study of women admitted to the hospital with acute pyelonephritis between May 2004 and April 2011.
Patients were included if the results of urine cultures and susceptibility testing to antibiotics were available. Epidemiological, clinical, therapeutical and outcome variables were collected from chart review. We considered inappropriate empirical antimicrobial treatment (IEAT) as the occurrence of microorganism that were not effectively treated at the time when the causative microorganism and its antibiotic susceptibility were known.
Results. Fifty women with appropriate microbiological data from a total of 93 cases of acute pyelonephritis were included in the study. The women’s mean age was 26.4 years, and 58% were nulliparous. Pyelonephritis was developed in the 2nd and 3rd trimester in 88% of cases. Previous urinary tract infections were recorded in 34%. Escherichia coli was the most frequent microorganism (70%). The proportion of patients who received IEAT was 10%. Amoxicillin-clavulanate and cepahlosporines were the most predominant antibiotics used, with a proportion of IEAT of 10.3% and 5.9%, respectively.
Conclusions. Pregnant women with pyelonephritis received IEAT in a small but significant number of cases. Amoxicillin-clavulante and cephalosporines were adequate in most cases. More studies are needed to define the clinical impact of IEAT on prognosis.

 

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Rev Esp Quimioter 2013:26(1):34-38

Invasion of solid culture media: a widespread phenotypic feature of clinical bacterial isolates                                  
 

F. GÓMEZ-AGUADO, M. T. CORCUERA, C. GARCÍA-REY,  M. L. GÓMEZ-LUS, C. RAMOS, M. J. ALONSO, J. PRIETO                  

Objectives. The in-depth growth in solid culture media is a common feature in filamentous fungi and yeasts. However, there are very few bacterial species in which this phenomenon has been documented. The aim of this work was to assess the agar invasiveness of a wide range of Gram-positive and Gram-negative bacterial species of clinical interest.
Material and methods. Three different clinical isolates for each of eleven bacterial species were plated onto Columbia blood agar and let grow up to 15 days. Isolated colonies were processed by histological methods, embedded in epoxy resin, and then, semithin sections were stained with toluidine blue and visualized by light microscopy.
Results. Growth within the agar was observed in at least one strain in 9 of the 11 studied species. Invasions of Gramnegative rods were small, not plentiful, and round or triangleshaped. In Gram-positive cocci, invasions were of big size, abundant and of variable shape (lentiform, globular, irregular, arrowhead) depending on the species.
Conclusions: We propose that the growth within the agar can indicate a survival strategy common to many bacterial species, and so far, not previously reported. This strategy could be either a nutrient gradient tropism or the spread and colonization of new ecological niches, with potential implications in pathogeny.

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Rev Esp Quimioter 2013:26(1):39-42

Relevance of the detection of Streptococcus pneumoniae antigen in human urine in the diagnosis of lower respiratory tract infections                                  
 

A. SORLÓZANO, S. CEDEÑO, J. GUTIÉRREZ-FERNÁNDEZ, P. POLO, J. M. NAVARRO                   

Background and objective. Techniques membrane antigen immunochromatographic detecting in urine the pneumococcal polysaccharide C, have developed significantly, increasing requests for antigenuria to clinical microbiology laboratories. We evaluated the impact of the application of this test in the diagnosis of infections of lower respiratory tract.
Patients and method. Six hundred and sixteen determinations were performed by antigenuria BinaxNOW® S. pneumoniae in as many patients over 14 years admitted to the Hospital Universitario Virgen de las Nieves (Granada) between November 2010 and March 2011.
Results. In 91.1% of patients who were determined antigenuria the presence of respiratory symptoms justified the request. Only 8.4% of 616 antigenurias performed were positive. S. pneumoniae was isolated from the respiratory sample culture in 8 of these 52 patients. In 29.8% of patients the diagnosis of lower respiratory tract infection was based on clinical, radiological and/or analytical, as antigenurias were negative and did not involve any other additional microbiological test.
Conclusions. We believe that this technique should be used in a complementary manner, and never to the detriment of other microbiological tests, especially in hospitalized patients.

Rev Esp Quimioter 2013:26(1):39-42 [pdf]

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Rev Esp Quimioter 2013:26(1):43-46

Aumento significativo de la resistencia a fosfomicina en cepas de Escherichia coli productoras de ß-lactamasas de espectro extendido (BLEE) aisladas de urocultivos (2005-2009-2011)                                   
 

C. RODRÍGUEZ-AVIAL, I. RODRÍGUEZ-AVIAL, E. HERNÁNDEZ, J. J. PICAZO                    

Introducción. Escherichia coli es el principal uropatógeno. La aparición de cepas productoras de β-lactamasas de espectro extendido (BLEE), que con frecuencia presentan multirresistencia, deja pocas opciones terapéuticas, y es necesario realizar un seguimiento de su sensibilidad a lo largo del tiempo. En el presente trabajo se presentan los porcentajes de aislados urinarios de E.coli productores de BLEE durante 2005, 2009 y 2011 y se comparan los resultados de la determinación de su sensibilidad a antibióticos de diferentes grupos, fosfomicina entre ellos.
Métodos. Se analizaron 5.053, 6.324 y 6.644 aislados urinarios de E. coli en 2005, 2009 y 2011 respectivamente. Se excluyeron duplicados. La sensibilidad se determinó por microdilución con el sistema Wider (Soria Melguizo S.A.) y se seleccionó el fenotipo que indicaba producción de BLEE (CLSI 2009).
Resultados. El 3,9% de las cepas (198) resultó productor de BLEE en 2005, el 7,3% (463) en 2009 y el 8,7% (584) en 2011. Se detectó resistencia a carbapenemicos en 2009, aunque continúan con un 95% de sensibilidad. Entre los no-β-lactámicos, colistina fue el más activo, seguido de nitrofurantoina. Ciprofloxacino y sulfametoxazol-trimetoprim presentaron un 80% y 60% de resistencia, respectivamente. Se observó una tendencia al aumento de la resistencia en fosfomicina, desde 0% a 9,3 llegando al 14,4% en 2011.
Conclusiones. Se observó una creciente prevalencia de cepas de E. coli productoras de BLEE aisladas de urocultivos, alcanzando el 8,7% en 2011. Los carbapenemicos siguen siendo los antibióticos más activos frente a este tipo de cepas. El aumento de resistencia a fosfomicina fue significativo.

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Rev Esp Quimioter 2013:26(1):47-50

Detection and genotyping of human respiratory viruses in clinical specimens from children with acute respiratory tract infections 
                                  

E. CULEBRAS, C. BETRIU, E. VÁZQUEZ-CID, E. LÓPEZ-VARELA, S. RUEDA, J. J. PICAZO                     

Respiratory virus infections are a major health concern and represent the primary cause of testing consultation and hospitalization for young children. The application of nucleic acid amplification technology, particularly multiplex PCR coupled with fluidic or fixed microarrays, provides an important new approach for the detection of multiple respiratory viruses in a single test. The aim of this study was to analyze respiratory samples from children with acute respiratory tract infection (ARTI) using a commercial array-based method (CLART® PneumoVir Genomica, Coslada, Spain). These tests were used to identify viruses in 281 nasopharyngeal samples obtained from children affected by ARTI. Samples were obtained form October 2008 to April 2009. Viruses were identified in 80% of the studied ARTI providing useful information on clinical features and epidemiology of specific agents affecting children in cold months. Multiple viral infections were found in 33.45% of the specimens.

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Rev Esp Quimioter 2013:26(1):51-55

Candida sp endocarditis. Experience in a third level hospital and review of the literature 
                                  

A.HERNÁNDEZ-TORRES, E. GARCÍA-VÁZQUEZ, A. LASO-ORTIZ, J. A. HERRERO-MARTÍNEZ, J. GÓMEZ-GÓMEZ                      

Despite the relative high frequency of Candida bloodstream infection, Candida endocarditis is a rare entity. We report five cases of Candida endocarditis admitted to our hospital in the period between 2005 and 2011. Two cases were caused by C. albicans, two cases were caused by C. parapsilosis and in the last one, we didn´t identify the species of Candida. All but one had clear risk factors for candidemia. Treatment consisted of amphotericin B with / without flucytosine in four patients, and they all underwent surgery for valve replacement and / or removal of intravascular devices. Overall mortality was 60% (40% of mortality was directly related to endocarditis). All patients who survived were given suppressive therapy with fluconazole for a minimum of two years. After stopping fluconazole there was a case of recurrence.

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Rev Esp Quimioter 2013:26(1):56-63

Use of tigecycline in critically ill patients with serious nosocomial intra-abdominal infections 
                                  

E. MASEDA, S. E. DENIS, A. RIQUELME, F. GILSANZ                        

Intra-abdominal infection (IAI) is a frequent complication found in surgical intensive care unit (SICU) and continues to be associated with considerable mortality. Tigecycline, the first-in-class glycylcycline has demonstrated a broad spectrum of activity against a wide range of bacteria commonly found in IAI. This observational retrospective study aimed to describe the experience with tigecycline for serious nosocomial IAI in the SICU. Data were collected from 23 consecutive patients admitted to SICU with serious nococomial IAI who had received empirical treatment with tigecycline. In all cases, IAI was diagnosed via emergency surgery. Severe sepsis was found in 56.5% and 43.5% developed septic shock. Oncological disease was the most common comorbidity (60%). The mean Simplified Acute Physiology Score (SAPS) III within 24 hours from IAI diagnosis was 57.5±14.7, and 87% showed a McCabe score >1 (2 or 3). Escherichia coli was the most common pathogen (43.5%), followed by Bacteroides spp. and Streptococcus spp. (30.4%, respectively). All but one patient received tigecycline in combination (95.7%), particularly with fluconazole (52.2%), followed by piperacillin-tazobactam (43.5%). Empirical antibiotic therapy was considered adequate in 95%. The mean duration of treatment was 8.5±4.5 days. A favorable response was achieved in 78%. Failure of the antibiotic therapy was not observed in any patient. None of the patients discontinued tigecycline due to adverse reactions. SICU mortality was 13%, with no deaths attributable to tigecycline. These findings suggest that tigecycline combination therapy is an effective and well tolerated empirical treatment of serious nosocomial IAI in the SICU.

Rev Esp Quimioter 2013:26(1):56-63 [pdf]

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