Identification of fungal clinical isolates by matrix-assisted laser desorption
ionization-time-of-flight mass spectrometry                                
 

LAURA FERREIRA, FERNANDO SÁNCHEZ-JUANES, SILVIA VEGA, MAGDALENA GONZÁLEZ, Mª INMACULADA GARCÍA, SILVIA RODRÍGUEZ, JOSÉ MANUEL GONZÁLEZ-BUITRAGO, JUAN LUIS MUÑOZ-BELLIDO
             

Background. Recently, bacterial identification by MALDI-TOF MS has acquired a high relevance in terms of speed and reliability. Conventional mycological identification has some disadvantages: it is frequently slow, reliability is sometimes low, and an extensive experience is required. The risk population for fungal infections, and therefore their clinical significance has progressively increased in recent years.
Methods. 153 yeast and mould clinical isolates were analyzed by MALDI-TOF MS and conventional identification. When both methods were discrepant to the genus or species level, ITS-2 sequencing was performed.
Results. The correlation in yeasts identification between conventional identification methods and MALDI-TOF MS was extremely high (99.2% to the species level and 100% to the genus level). The only discrepancy was checked by ITS-2 sequencing and confirmed the MALDI-TOF identification. The correlation in moulds identification was more heterogeneous. 68.7% of the isolates showed correlation at least to the genus level and 40.6% to the species level. Therefore, the correlation between conventional identification and MALDI-TOF MS in fungal identification was, in whole, 87% to the species level, and 93.5% to the genus level.
Conclusions. Identification of fungi by MALDI-TOF MS is reliable and shows potential advantages over conventional identification methods.

Rev Esp Quimioter 2013:26(3):193-197 [pdf]

Epidemiology of Clostridium difficile-associated disease (CDAD) in Salamanca                                 
 

MARÍA SILLER-RUIZ, NOELIA CALVO-GARCÍA, SARA HERNÁNDEZ-EGIDO, ANA MARÍA-BLÁZQUEZ, MÓNICA DE FRUTOS-SERNA, JOSÉ ELÍAS GARCÍA-SÁNCHEZ               

Introduction. Clostridium difficile infection is considered a major cause of nosocomial diarrhoea in developed countries and is increasingly becoming more important as an etiologic agent of community diarrhoea, also in patients without risk factors.
Method. Beginning in May 2011, the aim of our study is to know the characteristics of patients suffering from C. difficile Associated Disease in Salamanca University Hospital, collecting their data in a survey conducted for this purpose. A case was defined as a patient with compatible clinical and positive microbiological diagnosis.
Results. After 18 months of study, 41 cases had been documented representing an incidence of 1.15 cases per 10,000 patient-days. Patients were hospitalized (37) or health care associated (4), females (54%), age ≥65 years (56%) with prior antibiotic treatment (80%), most had diarrhea after the third day of admission, less than three weeks and without blood. Most were treated with metronidazole alone (78%), 19% with metronidazole and vancomycin, and the remaining percentage was resolved without treatment. Recurrences were about 20% and 7 (17%) died.
Conclusions. The characteristics of our patients with C. difficile – associated disease are the same as those reported by other authors. Local surveillance is important in order to study the endemic and epidemic C. difficile infection. According to published epidemiological changes, we sould be able to develop strategies from the Microbiology laboratories that will improve diagnosis of the disease.

Rev Esp Quimioter 2014:27(2):122-126 [pdf]

Psoas abscess associated with hip arthroplasty infection                                 
 

IBON LÓPEZ-ZABALA, SEBASTIÁN GARCÍA-RAMIRO, GUILLEM BORI, XAVIER GALLART, XAVIER TOMÁS,DAVID FUSTER, JOSEP MENSA, ALEX SORIANO
             

Introduction. Psoas abscess associated with hip arthroplasty infection is a rare entity. The aim of this report was to review our experience.
Material and methods. Patients with computerized tomography (CT) diagnosis of psoas abscess associated with a hip arthroplasty infection from 2004 to 2009 were retrospectively reviewed. Demographics, microbiological data, CT results and outcome of each patient were recorded.
Results. Seven patients out of 214 evaluated by CT due to hip infection suspected were identified. Three women and 4 men, with a mean age of 69 years (range 46-89). Mean abscess diameter was of 62x47mm. In all cases, a direct communication between abscess and prosthesis was observed. The most commonly isolated microorganisms were grampositive cocci. All patients were treated with two-stage revision surgery. After a mean follow-up of 65 months (28-113), six patients were in remission.
Conclusions. The use of CT in the study of suspected infection of a hip arthroplasty identified a psoas abscess in 7 cases out of 214 evaluated. Patients treated with two-stage revision surgery and large debridement was associated with a good clinical outcome.

Rev Esp Quimioter 2013:26(3):198-202 [pdf]

Correction: Antimicrobial stewardship in patients recently transferred to a ward from the ICU                                 
 

ANTONIO RAMOS, LAURA BENÍTEZ-GUTIERREZ, ANGEL ASENSIO, BELÉN RUIZ-ANTORÁN, CARLOS FOLGUERA, ISABEL SANCHEZ-ROMERO, ELENA MUÑEZ               

This paper is a corrigendum to the previously published paper: “Antimicrobial stewardship in patients recently transferred to a ward from the ICU” [Rev Esp Quimioter. 2014 Mar;27(1):46-50.] This corrigendum was prepared in order to correct some erroneous comments included in the discussion section. First, it should be pointed out that there could have been several suitable options for treating many infections and that, therefore, the word “inadequate” was not the most appropriate in this situation. In addition, some comments about the interpretation of microbiological results made by ICU physicians have been removed from the first article because this variable was not included in the study. Finally, another change made to the discussion was to clarify the ICU physicians’ alleged low level of compliance with advice given by infectious disease specialists. This has been suggested in previous studies it cannot be substantiated when analyzing the results of the study.
Purpose. Inappropriate use of antibiotics is an important health problem that is related to increasing bacterial resistance. Despite its relevance, many health institutions assign very limited resources to improving prescribing practices. An antimicrobial stewardship programme (APS) centred on patients discharged from the ICU could efficiently undertake this task.
Methods. During this six month study the main activity was performing a programmed review of antimicrobial prescriptions in patients transferred to the ward from the ICU. In the case of amendable antimicrobial treatment, a recommendation was included in the medical record.
Results. A total of 437 antimicrobial prescriptions for 286 patients were revised during a six month period and a total of 271 prescriptions (62%) in 183 patients were considered to be amendable. In most of these cases, treatment could have been reduced taking into consideration each patient’s clinical improvement and their location in a hospital area with a lower risk of infection due to resistant bacteria. The most common advice was antimicrobial withdrawal (64%), antimicrobial change (20%) and switching to oral route (12%). Proposed recommendations were addressed in 212 cases (78%). There was no significant difference in adherence with respect to the type of recommendation (p=0.417). There was a 5% lower use of antibiotics during the year the study was conducted compared to the previous one.
Conclusions. ASPs centred on patients discharged from the ICU may be an efficient strategy to ameliorate antimicrobial use in hospitals.

Rev Esp Quimioter 2014:27(2):134-139 [pdf]

Study of a cohort of patients with Enterococcus spp. Bacteraemia. Risk factors associated to high-level resistance to aminoglycosides                                
 

ELISA GARCÍA-VÁZQUEZ, HELENA ALBENDÍN, ALICIA HERNÁNDEZ-TORRES, MANUEL CANTERAS, GENOVEVA YAGÜE, JOAQUÍN RUIZ, JOAQUÍN GÓMEZ
             

Objectives. To analyze a cohort of patients with Enterococcus sp. bacteraemia.
Patients and methods. Retrospective and observational study of a cohort of non-pediatric in-patients with Enterococcus spp. bacteraemia (June 2007-September 2009). Data collection from clinical records was done according to a standard protocol. We analyzed epidemiological, clinical and microbiological data. Treatment with glycopeptides in non allergic patients or in case of betalactam susceptibility (ampicillin) was considered “optimizable”.
Results. Three were 106 cases of bacteraemia (2.2/1000 admitted patients; 84% E. faecalis); 83% had an underlying condition; 88% nosocomial or health related cases. Urinary infection was present in 20% and primary bacteraemia in 47%. High level resistance to gentamicin (HLRG) was present in 60%; there was no vancomycin or linezolid resistance. Most frequent empiric treatments were penicillin-betalactamase inhibitor (25%) and glycopeptides (22%). Most frequent definitive treatment was glycopeptides (34%), being “optimized” 21% and 44% of empiric and definitive treatments, respectively. Mortality was 23% (related, 14%). In the multivariate analysis, risk factors associated with HLRG were nosocomial acquired infection (OR 6.083; 95CI% 1.428-25.915) and no-abdominal origin (OR 6.006; 95CI%1.398-25.805). In multivariate analysis, independent risk factors for mortality were: Pitt > 3 (OR 14.405; 95CI%2.236-92.808) and active empiric treatment (OR 8.849; 95CI% 1.101-71.429).). Incidence in previous cohort was similar but HLRG rate has increased.
Conclusions. Risk factors associated with HLRG were nosocomial acquired infection and no-abdominal origin. Risk factors for mortality were initial clinical severity and having received active empiric treatment. HLRG rate has increased.

Rev Esp Quimioter 2013:26(3):203-213 [pdf]