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.

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

/por

Rev Esp Quimioter 2013:26(2):173-188

Epidemiology, diagnosis and treatment of fungal respiratory infections in the critically ill patient                                
 

JOSÉ GARNACHO-MONTERO, PEDRO OLAECHEA, FRANCISCO ALVAREZ-LERMA, LUIS ALVAREZ-ROCHA,  JOSÉ BLANQUER, BEATRIZ GALVÁN, ALEJANDRO RODRIGUEZ, RAFAEL ZARAGOZA, JOSÉ-MARÍA AGUADO, JOSÉ MENSA, AMPARO SOLÉ, JOSÉ BARBERÁN
             

Objective. To elaborate practical recommendations based on scientific evidence, when available, or on expert opinions for the diagnosis, treatment and prevention of fungal respiratory infections in the critically ill patient, including solid organ transplant recipients.
Methods. Twelve experts from two scientific societies (The Spanish Society for Chemotherapy and The Spanish Society of Intensive Care and Coronary Units) reviewed in a meeting held in March 2012 epidemiological issues and risk factors as basis for a document about prevention, diagnosis and treatment of respiratory fungal infections caused by Candida spp., Aspergillus spp or Zygomycetes.
Results. Despite the frequent isolation of Candida spp. from respiratory tract samples, antifungal treatment is not recommended since pneumonia by this fungal species is exceptional in non-neutropenic patients. In the case of Aspergillus spp., approximately 50% isolates from the ICU represent colonization, and the remaining 50% cases are linked to invasive pulmonary aspergillosis (IPA), an infection of high mortality. Main risk factors for invasive disease in the ICU are previous treatment with steroids and chronic obstructive pulmonary disease (COPD). Collection of BAL sample is recommended for culture and galactomannan determination. Voriconazole and liposomal amphotericin B have the indication as primary therapy while caspofungin has the indication as salvage therapy. Although there is no solid data supporting scientific evidence, the group of experts recommends combination therapy in the critically ill patient with sepsis or severe respiratory failure. Zygomycetes cause respiratory infection mainly in neutropenic patients, and liposomal amphotericin B is the elective therapy.
Conclusions. Presence of fungi in respiratory samples from critically ill patients drives to different diagnostic and clinical management approaches. IPA is the most frequent infection and with high mortality.

Rev Esp Quimioter 2013:26(2):173-188 [pdf]

/por

Rev Esp Quimioter 2014:27(1):1-16

Clinical indications for therapeutic drug monitoring of antifungal agents. In the way for optimizing the treatment of fungal infection                                 
 

EMILIO CENDEJAS-BUENO, MANUEL CUENCA-ESTRELLA, ALICIA GÓMEZ-LÓPEZ               

Therapeutic drug monitoring as a tool in the management of infectious diseases has been introduced in therapy with anti-infective agents for years. Nowadays, it has taken importance in the management of fungal diseases due to the appearance of new antifungal drugs such as new-generation azoles. These azoles have pharmacokinetic characteristics that hinder a proper use to ensure efficacy and minimize toxicity. Monitoring of serum concentrations may help in the better use of these anti-infective agents, as well as in a better management of drug interactions, infectious disease and adverse effects. It has resulted in saving costs of treatment and in avoiding inadequate dosages. This review will attempt to clarify the role of the antifungal agents Therapeutic Drug Monitoring, highlighting the role of azole compounds.

Rev Esp Quimioter 2014:27(1):1-16 [pdf]

/por

Rev Esp Quimioter 2014:27(2):115-121

Review of 1.250 episodes of skin and soft tissue infections attended at 49 hospital emergency departments                                 
 

FERRAN LLOPIS, JUAN GONZÁLEZ-CASTILLO, AGUSTÍN JULIÁN-JIMÉNEZ, CARLES FERRÉ, JULIO JAVIER GAMAZO-RÍO, MIKEL MARTÍNEZ Y EL GRUPO DE TRABAJO INFURG-SEMES               

Objetive. To review the prevalence, clinical characteristics, approach and outcome of patients with skin and soft tissue infections (SSTI) evaluated at the Emergency Departments (ED) in Spain.
Methods. A descriptive multicenter cross-sectional analysis in 49 ED of patients with SSTI. Data were collected for age, gender, comorbid conditions, risk factors for multiresistant pathogens, STTI type, sepsis criteria, microbiology, antibiotic treatment, destination and ED mortality.
Results. We documented 1,250 episodes (11% of all infections and 1.6% of all patients seen in ED), mean age 52 years (56% men) and the comorbidities and risk factors for major adverse outcomes were diabetes (15%), heart disease (12%), previous antibiotic therapy (10%) and solid malignancy (5%). 81% of STTI were nonnecrotizing, 3.3% had septic syndrome, in 65% of patients was not practised any microbiological study, and 16% had risk factors for infection for antibiotic-resistant gram-positive bacteria, with adequate empirical antibiotic therapy of 2.5%. 72% of patients were discharged home and 2 died. When comparing STTI discharged home respect those that were admitted, these latter were older patients with more comorbidities and risk factors for multidrug resistance, sepsis and there were more practised cultures (p < 0.05).
Conclusions. The SSTI have a prevalence of 1.6%, representing 11% of visits to the ED for infection. 44% of patients have comorbidity and 16% have risk factors for infection for resistant gram-positive pathogens and they were not made an appropriate antibiotic coverage.

Rev Esp Quimioter 2014:27(2):115-121 [pdf]

/por

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.

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

/por

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

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]

/por

Rev Esp Quimioter 2014:27(1):17-21

Antifungal susceptibility of clinical isolates of Scopulariopsis species                                
 

VALLE ODERO, LIDIA GARCÍA-AGUDO, INMACULADA GUERRERO, PILAR AZNAR, PEDRO GARCÍA-MARTOS, MANUEL RODRÍGUEZ-IGLESIAS               

Introduction. Scopulariopsis is a common soil saprophyte. In the last years the infections caused by Scopulariopsis species have increased, included superficial and invasive mycoses. This fungi has been reported resistant in vitro to some antifungal agents, although there is little information about this. The aim of the study was to establish in vitro antifungal susceptibility of clinical isolates of Scopulariopsis species against to broad-spectrum antifungal agents.
Methods. A total of 28 Scopulariopsis strains (10 S. brevicaulis, 7 S. koningii, 3 S. acremonium, 3 S. candida, 3 S. flava, 1 S. brumptii and 1 S. fusca) were tested using Sensititre YeastOne and broth microdilution methods to determine the minimum inhibitory concentrations (MICs) to amphotericin B, fluconazole, itraconazole, posaconazole, voriconazole and 5-fluorocytosine, and minimun effective concentration (MECs) to anidulafungin, caspofungin and micafungin.
Results. Our data confirm the high in vitro resistance of Scopulariopsis to antifungal agents. Anidulafungin, caspofungin, micafungin (MICs ≥8 mg/L), 5-fluorocytosine (MICs ≥64 mg/L), and fluconazole (MICs ≥128 mg/L) were inactive in vitro in all species. MICs of amphotericin B (range 2 to ≥8 mg/L) and itraconazole (0.5 to ≥16 mg/L) were high. The best antifungal activity was observed for posaconazole and voriconazole (0.5 to ≥8 mg/L). With Sensititre YeastOne method MICs obtained slightly lower. Scopulariopsis candida, S. flava and S. fusca were the most resistant species, while S. acremonium and S. brevicaulis showed the lowest MICs.
Conclusions. MICs of all tested antifungal agents for Scopulariopsis were very high. Infections caused by Scopulariopsis species may not respond to antifungal treatment. Voriconazole is the drug of choice for treatment. We consider it appropriate to add amphotericin B in serious infections.

Rev Esp Quimioter 2014:27(1):17-21 [pdf]

/por

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

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]

/por

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.

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

/por

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

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]

/por