Rev Esp Quimioter 2009:22(4):201-206

Brain abscess in a third-level hospital: epidemiology and prognostic factors related to mortality

M. GUITIÉRREZ-CUADRA, M.A. BALLESTEROS, A. VALLEJO, E. MIÑAMBRES, C. FARIÑAS-ÁLVAREZ, J.D. GARCÍA-PALOMO, A. VÁZQUEZ, M.C. FARIÑAS

 

Objective. To document the epidemiology, causes, treatment and prognostic factors associated with mortality of patients with brain abscess in a tertiary medical center.

Methods. Observational retrospective cohort study of patients with cerebral abscess admitted at a tertiary hospital during 13 years.

Results. The case records of 71 patients admitted to a tertiary hospital between January 1992 and December 2005 and diagnosed of brain abscess were review. Brain abscess occurred at all ages, more frequently in men than in women. Fever, headache and altered mental status were common presenting symptoms. The most common site of infection was the frontal lobe (28 patients).Seventeen patients had multiple abscesses. Staphylococcal infection was seen most commonly. Computed tomography provided sufficient diagnostic information in all cases. Twenty six patients had early surgical drainage. Thirty four patients were admitted to the intensive care Unit (ICU). The overall mortality was 21% (15 patients), all of that related to the infection. Six patients died in ICU. More than 65 years of age (OR, 1,0; CI 95%, 1,0-1,1), medical treatment without surgery (OR, 8,9; CI 95%,1,1-73,8), presence of multiple abscesses, (OR, 6,0; CI95%, 1,0-34,9), immunosuppression (OR, 21,5; CI 95%, 2,9-157,2) and delay in starting antibiotherapy (OR, 1,5 per day of delay; CI 95%, 1,0-2,1) were independent predictors of in-hospital death.

Conclusions: In spite of improvement in diagnosis and treatment of patients with cerebral abscess, mortality is still high. Factors related to patient underlying diseases and the delay in the start an antibiotic treatment were associated with increased mortality (50% increase of mortality risk per day in the delay of starting antibiotherapy).

Rev Esp Quimioter 2009:22(4):201-206 [pdf]

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

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] 

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Rev Esp Quimioter 2009;22(4):180-189

Breastfeeding and antiinfectious agents 

M. T. HERNÁNDEZ, J. M. PARICIO, J.PEMÁN, M. SÁNCHEZ,  B. BESELER, M. J. BENLLOCH   

 

Not infrequently an infection or an antibiotic treatment needed by a lactating mother leads to medical advice against breast feeding. However, advising against breastfeeding increases morbimortality risk in the infant. Besides there are few anti-infectious agents not compatible with breastfeeding, and in these cases, there is usually an alternative to treat the mother’s illness. Thus it is important for health professionals to be informed of best sources where to look for the best treatment for the mother compatible with breastfeeding. This article offers the reader a review of basic pharmacodynamics which influence drug use in human lactation, an alphabetically ordered list of available anti-infectious agents coded by numbers indicating risk level, and some web recommendations for the interested reader. We hope to offer the interested reader a useful tool which may prevent some cases of physician led abandonment of lactation.

Rev Esp Quimioter 2009;22(4):180-189 [pdf]  

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Rev Esp Quimioter 2009;22(4):173-179

Glycopeptide heteroresistance and tolerance in hospital grampositive isolates: “invisible” phenomena to the clinician with clinical implications?

L. AGUILAR, M. J. GIMÉNEZ, J. BARBERÁN  

  

This article reviews the concepts of heteroresistance and tolerance to glycopeptides in gram-positive bacteria isolated from hospitalised patients. Heteroresistance (resistant subpopulations among the total bacterial population of the strain, that can be selected by the treatment) and tolerance (capability of survival, but not growth, in the presence of usually lethal antibiotic concentrations) have in common several characteristics: 1) the absence of its determination in laboratory daily practice, 2) they implied a decrease in antimicrobial activity not reflected in MIC values (thus being “invisible” to clinicians in daily routine laboratory reports), 3) the decrease in antimicrobial activity may have clinical implications and 4) they affect a wide spectrum of gram positive bacteria in the hospital (Staphylococcus aureus, coagulase-negative staphylococci, enterococci and different estreptococcal species). The decrease produced in the bactericidal activity (that is critical for the treatment of bacteremias, endocarditis, meningitis and infections in immunocompromised patients) has clinical implications such as persistance of bacteremia, refractory bacteremia, relapse of infections and increased length of stay. Two strategies are possible to overcome tolerance and heteroresistance: addition of antibiotics to obtain bactericidal activity by synergism (key factor for which it should be taken into account antagonic combinations or high resistance to aminoglycosides when choosing the antibiotic regimen),or the use of bactericidal compounds to which gram-positive bacteria show susceptibility and absence of heteroresistance and tolerance (in contrast to glycopeptides), as is the case of lipopeptide daptomycin.

Rev Esp Quimioter 2009;22(4):173-179 [pdf]  

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Rev Esp Quimioter 2009:22(3):127-134

Pilot Drug Utilization Study of systemic antifungal agents in the Hospital Clínico San Carlos. Proposal of a study method

S. Alonso ,  A. Arribi ,  J. Vergas ,  M. C. Martín ,  B. Arce ,  A. Terleira y A. Portolés 

  

Introduction. The study aims to define a method for the evaluation of the usage of systemic antifungal agents, and test it, in order to be able to develop larger studies.

Method. Drug Use Study, pilot, observational, prescription- indication. We proposed a definition of antifungal type of treatment using as host factors the EORTC (European Organization for Research and Treatment of Cancer) criteria, the patient’s clinical data as well as any evidence of fungal infection. Adequate use was evaluated by three standards of comparison: summary of product characteristics, hospital recommendations and an experts’ committee.

Results. 60 antifungal prescriptions were recovered: fluconazole: 39; itraconazole: 6; liposomal amphotericin B: 5; caspofungin: 5; voriconazole: 5. Treatment was started as follows (N;%): microbiological (28;46.7), empirical (22;36.7) and prophylactic use (7;11.7). The indication for antifungal treatment was considered adequate in more than 90% of the cases for the three standards of comparison, whereas selection in 75-83% of the cases.

Conclusions. The method is considered satisfactory for the evaluation of antifungal treatments and is proposed for being used in larger studies. For all the antifungal agents evaluated, a high degree of appropriateness of use was found, though some conditions are considered improvable.

Key words:Antifungal agents. Drug utilization study. Study method. Prescription. Appropriateness. Indication. Selection of drugs.    

 

Rev Esp Quimioter 2009:22(3):127-134 [pdf]

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Rev Esp Quimioter 2009:22(3):151-172

Recommendations in the empiric anti-infective agents of intra-abdominal infection

X. Guirao ,  J. Arias ,  J. M.ª Badía ,  J. A. García-Rodríguez ,  J. Mensa ,  F. Álvarez-Lerma ,  M. Borges ,  J. Barberán ,  E. Maseda ,  M. Salavert ,  P. Llinares ,  M. Gobernado y C. García Rey 

  

A significant number of patients with abdominal infection develop advanced stages of infection and mortality is still above 20%. Failure is multifactorial and is associated with an increase of bacterial resistance, inappropriate empirical treatment, a higher comorbidity of patients and poor source control of infection. These guidelines discuss each of these problems and propose measures to avoid the failure based on the best current scientific evidence.

 

Key words: Intra-abdominal infection. Guidelines. Anti-infective agents

Rev Esp Quimioter 2009:22(3):151-172  [pdf]

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Rev Esp Quimioter 2009:22(3):144-150

Cefditoren and community-acquired lower respiratory tract infections

J. Barberán and J. Mensa 

  

Cefditoren is a third-generation oral cephalosporin with good activity against respiratory tract pathogens, including penicllin–intermediate and —resistant strains of S. pneumoniae, and β-lactamase producing strains of H. influenzae and M. catarrhalis. Its bacterial activity, measured by minimum inhibitory concentration (MIC), is similar or superior to that of many other commonly used antibiotics (penicillins, cephalosporins and fluoroquinolones). Considering the target attainment of T > MIC of ≥ 40% a more reliable predictor of clinical and microbiologic outcomes, cefditoren covers strains of S. pneumoniae with MIC values ≤ 0.5 μg/mL and ≤ 1 μg/mL in the case of doses of 200 mg and 400 mg, respectively, and all strains of H. influenzae. Cefditoren has been associated with high rates of bacteriologic response among the main causative pathogens in lower respiratory tract infection (~–85% against H. influenzae and ~–90% against S. pneumoniae, including penicillin-intermediate and penicillin-resistant strains). It is a reliable option for switch therapy in case of treatment with third-generation intravenous cephalosporin. Cefditoren is currently approved in Spain for the treatment of adults and adolescents with acute exacerbations of chronic bronchitis (AECB) and community-acquired pneumonia (CAP), two of the lower respiratory tract infections most commonly encountered in clinical practice.

 

Key words: Cefditoren. Respiratory tract infections. Haemophilus influenzae. Streptococcus pneumoniae.

Rev Esp Quimioter 2009:22(3):144-150 [texto completo ESPAÑOL] [full text ENGLISH]

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Rev Esp Quimioter 2009:22(3):139-143

In vitro activities of posaconazole, fluconazole, itraconazole, ketoconazole and voriconazole against Candida glabrata

M. T. Blanco ,  J. Cañadas ,  P. García-Martos ,  P. Marín. ,  A. García-Tapia ,  M.J. Rodríguez 

  

This study has been conducted to asses the in vitro activity of the novel triazole antifungal agent posaconazole against 123 clinically important isolates of yeasts. Susceptibility was tested using the Sensititre YeastOne microdilution commercial method. Minimun inhibitory concentrations (MICs) were determined at the recommended endpoints and time intervals. The activity of posaconazole against Candida glabrata was compared with those of fluconazole, itraconazole, ketoconazole and voriconazole. The most susceptible species to posaconazole were C. albicans, C. parapsilosis, C. tropicalis and C. dubliniensis. Candida glabrata was the least susceptible. The percentage of strains with MIC for posaconazole ≥ 1 mg/L was 9%, all of them were C. glabrata. The species with MIC for itraconazole ≥ 0.5 mg/L were 36% (41 C. glabrata, 1 C. krusei, 1 C. guilliermondii, 1 C. ciferrii). Candida glabrata strains resistant to fluconazole, ketoconazole and voriconazole were 8%, 4% and 4%, respectively. Posaconazole exhibited good activity to the majority of Candida species. However, it was similar to itraconazole and less active than ketoconazole and voriconazole against C. glabrata.

 

Key words: Posaconazole. Yeasts. Candida glabrata.

Rev Esp Quimioter 2009:22(3):139-143  [pdf]

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Rev Esp Quimioter 2009:22(3):135-138

Activity of Ertapenem and Ceftriaxone in the eradication of Salmonella in a model of experimental peritonitis in mice

F. S. Lozano ,  M. I. García ,  E. García ,  B. González ,  M. B. García ,  F. J. García y J. E. García 

  

Since the beginning of the 1990s, the prevalence of isolates of non-typhoidal Salmonella species resistant to antimicrobial agents, including those commonly used for the treatment of Salmonella infections such as fluoroquinolones, trimethoprim-sulfamethoxazole or â-lactams, has increased substantially. Infections caused by multidrugresistant strains of non-typhoidal Salmonella are now frequently encountered. In order to consider an appropriate role of Ertapenem in Salmonella-due intraabdominal infections, in the present study we compare the efficacy of Ertapenem versus that of Ceftriaxone in a mouse peritonitis model. Bacteriological eradication from blood, liver and mesenteric lymph nodes was observed after 5 and 7 days of treatment in all infected mice receiving ceftriaxone. Although both antimicrobial agents —Ertapenem and Ceftriaxone— were observed to be effective in reducing mortality in inoculated mice, our data suggests a reduced efficacy of Ertapenem in the bacteriological eradication of Salmonella enterica serotype Typhimurium in a mouse peritonitis model.

  

Key words: Ceftriaxone. Ertapenem. Bacteriological eradication. Experimental peritonitis. 

Rev Esp Quimioter 2009:22(3):135-138 [pdf]

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Rev Esp Quimioter 2009:22(3):120-126

Antimicrobial susceptibility and molecular typing of Enterococcus faecium idolated from humans, chickens and environment in Canary Islands (Spain)

M. González ,  O. Afonso y M. T. Tejedor 

  

Comparative studies on antimicrobial susceptibility patterns and molecular typing of Enterococcus isolates of different origins provides valuable information concerning the epidemiology of enterococcal infections. We analyzed clinical isolates and we surveyed faecal samples of humans (hospitalised patients and healthy volunteers), faecal samples of poultry and environmental samples. A total of 68 E. faecium isolates were obtained: 43 from humans, 5 from poultry and 20 from water. We compared the antibiotic resistance patterns and pulsed field gel electrophoresis (PFGE) profiles of these strains. We used polymerase chain reaction (PCR) to examine them for the presence of 8 aminoglycoside resistance genes. Differences among percentages of antimicrobial resistance between clinical and non clinical isolates were found. All enterococci were susceptible to vancomycin and teicoplanin. Four aminoglycoside resistance genes were detected, most frequently ant(6)-Ia and aph(3’)-IIIa. Presence of isolates resistant to gentamicin but negative for all genes tested suggest that additional resistance genes may exist. VRE are still rare inside and outside hospitals in Gran Canaria (Spain). The high frequency of ampicillin resistance among clinical enterococci and the fact that several isolates share the same PFGE type were isolated from different wards of our hospital suggest that ampicillinresistant E. faecium are endemic in our Hospital.

 

Key words:Antimicrobial resistance. E. faecium. Polymerase chain reaction (PCR). Pulsed field gel electrophoresis(PFGE).

Rev Esp Quimioter 2009:22(3):120-126  [pdf]  

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