Bugs, hosts and ICU environment: Countering pan-resistance in nosocomial microbiota and treating bacterial infections in the critical care setting 

EMILIO MASEDA, JOSÉ MENSA, JUAN-CARLOS VALÍA, JOSE-IGNACIO GOMEZ-HERRERAS, FERNANDO RAMASCO, ENRIC SAMSO, MIGUEL-ANGEL CHIVELI, JORGE PEREIRA, RAFAEL GONZÁLEZ, GERARDO AGUILAR, GONZALO TAMAYO, NAZARIO OJEDA, JESÚS RICO, MARÍA JOSÉ GIMENEZ, LORENZO AGUILAR             

ICUs are areas where resistance problems are the largest, and they constitutes a major problem for the intensivist’s clinical practice. Main resistance phenotypes among nosocomial microbiota are: i) vancomycin-resistance/heteroresistance and tolerance in grampositives (MRSA, enterococci) and ii) efflux pumps/enzymatic resistance mechanisms (ESBLs, AmpC, metallobetalactamases) in gramnegatives. These phenotypes are found at different rates in pathogens causing respiratory (nosocomial pneumonia/ventilator-associated pneumonia), bloodstream (primary bacteremia/catheter-associated bacteremia), urinary, intraabdominal and surgical wound infections and endocarditis in the ICU. New antibiotics are available to overcome non-susceptibility in grampositives; however, accumulation of resistance traits in gramnegatives has lead to multidrug resistance, a worrisome problem nowadays. This article reviews by microorganism/infection risk factors for multidrug resistance, suggesting adequate empirical treatments. Drugs, patient and environmental factors all play a role in the decision to prescribe/recommend antibiotic regimens in the specific ICU patient, implying that intensivists should be familiar with available drugs, environmental epidemiology and patient factors.

Rev Esp Quimioter 2013:26(4):312-331 [pdf]

Prospective follow-up of results of tuberculosis treatment                                 
 

MARTA MORENO-GÓMEZ, MONTSERRAT ALONSO-SARDÓN, HELENA IGLESIAS-DE-SENA, LUCIANA LUCENA ARANHA DE MACÈDO               

Objective. The aim of the study was to analyze tuberculosis treatment outcomes in a health area of the National Health System.
Material and Methods. Analytical cohort study of tuberculosis’ cases treated in the hospital care of the health area of Salamanca (Spain) 6 months. The clinical record constituted the basic source of data, whose information was complemented by a clinical interview to the patient. The microbiological records were additionally used for classifying the therapeutic outcomes in satisfactory outcome (SO), potentially unsatisfactory outcome (PUO) and death. A total of 146 patients met the inclusion criteria; 108 patients were interviewed. Their average age was 49 years. Out of them, 29.6% (32/108) showed some social risk factor (SRF).
Results. The SO level was 55.6% (IC 95%: 55.6±9); the variables associated with the SO were young elderly patients, living in family and patterns of 6 months. The PUO proportion stood at 40.7% (IC 95%: 40.7±9); the variables which increased the PUO probability were adulthood, residing in other provinces, living alone, comorbidity, human immunodeficiency virus (HIV), alcoholism and social maladjustment. The variables included in the final model for PUO in logistic regression were adult, comorbidity and SFR, while the institutional conditions associated the mortality.
Conclusions. The SO rates can be improved. The PUO level is conditioned by high loss rates, 31.5% (95% CI: 31.5 ± 9), so measures should be established for reduction and improve the effectiveness of the overall treatment.

Rev Esp Quimioter 2014:27(4):244-251 [pdf]

Influenza surveillance by molecular methods

A. TENORIO, J. M. EIROS, E. RODRÍGUEZ, J. F. BERMEJO, M. DOMÍNGUEZ, T .VEGA, J. CASTRODEZA, R. ORTIZ

 

Introduction: Our objective was to evaluate the application of molecular techniques in the surveillance of influenza, and to describe clinical and epidemiological characteristics of cases diagnosed in 2007-2008 and2008-2009 seasons.

Methods: We analyzed 183 pharyngeal swabs from the same number of patients referred to the virology laboratory of the Sentinel Physician Network of Castilla y Leon, the study of influenza viruses by shell-vial technique and RT-PCR capable of detecting multiple Simultaneously, influenza virus A, B, C, respiratory syncytial virus A, B and adenovirus.

Results: Using cell culture were isolated 17 influenza A viruses and 19 influenza B viruses (19.7% of total). By multiple RT-PCR, was detected 49 influenza A virus, 29 influenza B virus, an influenza virus C, 3 syncytial virus type A and other B and 6 adenoviruses (44.3% of total). All influenza viruses isolated in cell culture was detected by RT-PCR. RT-PCR by 5 co-infections were detected, which represented a 6.25% of co-infections on the whole of positive samples. The average age of patients was 29 years (SD = 21.07). The proportion of women and men accounted for 43.7% and 56.3% respectively. The number of cases diagnosed in relation to age follows a pattern of negative linear correlation.

Conclusions: RT-PCR is revealed as an useful tool for epidemiological surveillance of influenza, allowing also to detect viral subtypes along with other viruses involved in respiratory infections.

Rev Esp Quimioter 2009:22(4):214-220 [pdf]  

Evaluation of three Immunochromatographic Assays for Detection of Legionella pneumophila serogroup 1 Antigen in Urine Samples

M. J. MUÑOZ, M.C. MARTÍNEZ, G. YAGÜE, M. SEGOVIA

 

The Uni-Gold, the SAS and the Binax NOW immunochromatographic test (ICT) urinary antigen assays for the qualitative detection of Legionella pneumophila serogroup 1 were compared using 39 unfrozen and nonconcentrated urine samples from patients with Legionnaires´disease (LD). The Uni-Gold anti-gen test detected the urinary antigen in 41% (16/39), the SAS antigen test in 61.5% (24/39), and the Binax NOW antigen test in 74.3% (29/39). The Binax NOW ICT assay showed the best results when detecting L. pneumophila urinary antigen.

Rev Esp Quimioter 2009:22(4):207-209 [pdf]

Vaccination and postexposure prophylaxis in heath-care workers      

M. N. GUTIÉRREZ, M. C. SÁENZ  

 

Health-care workers are an important professional group exposed to biological risks during their professional activity. The legal regulation of the occupational exposure, as well as the knowledge of occupational diseases, has facilitated the development of prevention measures for this group. Nowadays, vaccination against a number of infectious diseases is considered the most effective strategy of primary prevention. The recommended vaccines include those, according to age, included on adult immunization schedule, and vaccines against infectious diseases that can constitute a major risk, both for the professional and for the patient: chicken pox, rubella, HBV,.On the other hand, the occupational exposure to blood or other body fluids (transmission of HIV, HCV and HBV) is the main risk for health-care workers. Nevertheless, at this moment there is no effective immunoprophylaxis against any disease of this group, excepting HBV infection. Thus, occupational exposure prevention, chemoprophylaxis with anti-retroviral drugs when available, and exposure follow-up are the main strategies to decrease transmission risk.

Rev Esp Quimioter 2009:22(4):190-200 [pdf]