Viral Load in Spanish HIV patients: trends since the introduction of HAART

J. M.ª Eiros ,  E. Sánchez-Padilla ,  F. J. Luquero ,  B. Nogueira ,  S. Rojo ,  J. Atienza-Herrero y R. Ortiz de Lejarazu 

The aim of this study is to describe trends in the percentage of samples with undetectable HIV viral load in Spain after the implementation of HAART. A descriptive observational study of HIV-VL measurements carried out in the microbiology department of the Hospital Clínico Universitario de Valladolid (HCUV) was conducted over a 9-year period (1996-2004). Regarding the trend over the study period, the 30-39 years age group accounted for most of the samples, although the percentage decreased from 65.5 % to 59.6% over the study period. In contrast, the 40-49 years group increased from 9.1 % to 14.5 %. The preponderance of men, with percentages above 70 %, was observed during the whole period. Although the purpose of this treatment is to maintain undetectable viral loads, since 1999 more than 60% of nonfirst samples had detectable levels. Based on the results of the VL trend among HIV/AIDS patients observed in this study, a large number of patients maintain elevated detectable VL years after HAART was implemented. Although different factors may be the cause of this and should be delimited in future studies, the phenomenon observed demonstrates the usefulness of monitoring VL and analyzing its time trend to gain further knowledge about the therapeutic results and care of HIV patients as a whole, also serving as the basis for corrective measures.

Key words:HIV, Viral Load, HAART.

Rev Esp Quimioter 2009;22(1):34-37  [pdf] 

In vitro activity of fosfomycin against ESBL-producing enterobacteria of urinary origin

M.ª S. Hernández ,  J. Á. García y J. L. Muñoz 

In vitro activity of fosfomycin, compared with other antibiotics used for urinary tract infections (UTI), against extended spectrum beta-lactamase (ESBL)-producing Escherichia coli and Klebsiella pneumoniae clinical isolates obtained from UTIs, was determined. The activity of fosfomycin, co-trimoxazole, ciprofloxacin, nitrofurantoin, amoxicillin/ clavulanic acid and gentamicin against 71 ESBL-producing E. coli clinical isolates and 13 ESBL producing K. pneumoniae clinical isolates obtained from UTI was studied by the agar-dilution method or E-test. E. coli isolates produced mainly CTX-M type ESBL (76.1%), especially CTX-M 14 (56.3 %). K. pneumoniae isolates produced most predominantly SHV-type ESBL (92.3%), mainly SHV-2 (76.9 %). Gentamicin (4.4 %), fosfomycin (5.6 %) and nitrofurantoin (5.6 %) showed the lowest resistance proportions against E. coli. Co-trimoxazole and ciprofloxacin (7.7 %) showed the lowest resistance proportions against K. pneumoniae.

Key words: Escherichia coli. Klebsiella pneumoniae. Extended spectrum beta-lactamase (ESBL). Fosfomycin.

Rev Esp Quimioter 2009;22(1):25-29  [pdf]

Multicenter national survey on infection management in patients with penicillin allergy

R. Serrano ,  J. A. Capdevila ,  J. Mensa y J. Barberán ,  R. Oltra

Introduction. Beta-lactam antibiotics are widely prescribed to treat many infections because of efficacy, spectrum and safety. Their use is limited in patients with resistant microbial agents and in those with a history of penicillin allergy (HPA) because of cross-reactivity risk. Accurate clinical assessment of possible HPA requires specialized resources not always available in clinical practice. We intended to get to know the opinion of Spanish physicians about frequency and methods of evaluation of the patients with HPA as well as the preferences in the use of antimicrobial alternatives for common infectious diseases in patients with HPA.

Methods. Multicentric cross-sectional descriptive study ran by the Infectious Diseases Study Group of the Spanish Society for Internal Medicine based on the accomplishment of a survey of 10 questions of opinion to specialist doctors who work in Spanish medical centers.

Results. A total of 311 doctors responded to the survey (92.2% Internal Medicine specialists) distributed by all the Spanish territory. An average of 10.7% of patients self-reported having HPA although only an average of 10.8 % of them gave documentation on the matter. Patients were sent for specific allergy tests in an average of 33.6 %. Desensitization treatments were performed in 4.3 % of cases. The preferences for alternative antibiotic therapy to beta-lactan widely varied according to the infectious picture and the communitarian or nosocomial origin, and they included quinolones, macrolides, glycopeptides, lincosamides, oxazolidinones and tigecycline.

Conclusions. Perception about frequency and evaluation of patients with HPA is very variable, but in more than half the cases it is above 10 % of the patients. Yet, only one third are sent for in-depth study for allergy confirmation, and less than 5% are desensitized. Nosocomial infections and the possibility of multiresistant bacteria make substantially difficult the management of patients with HPA.

Key words:Beta-lactam antibiotics. Hypersensibility. Drug allergies. Tigecycline. Desensitization treatment.   

Rev Esp Quimioter 2009;22(1):10-19 [pdf]   

Pharmacoeconomics of infection in the intensive care unit

S. Grau ,  F. Álvarez-Lerma 

The intensive care unit (ICU) services are areas that have a need for greater use of economic resources, including the frequent use of higher priced drugs, standing out among them those corresponding to antimicrobial agents. This situation has led many hospital sites to include the ICU within those units needing special monitoring in regards to the use of drugs and the introduction of cost-containment programs in the ICU. It is possible that indiscriminate restriction in the financial cost section aimed at antimicrobial agents may mean that these drugs may be prescribed more inappropriately, a practice that has been related with greater mortality of patients with severe infections. Thus, the pharmacoeconomics of infection in the ICU should be analyzed through the study of different aspects and not only from the strict analysis of direct cost of the antimicrobial agents. In the present review, the cost of infection in the ICU has been analyzed, contemplating a series of perspectives that are considered essential and demonstrating, at all times, that evaluation of the cost of acquiring the antimicrobial agent as the only element for its choice should be avoided. The analysis was made by evaluating cost of infection in the ICU, the strategies for the control of use and cost of antibiotics in the ICU, importance of adequate early empiric treatment, the costs associated with the development of bacterial resistances and pharmacoeconomic studies.

Key words: Pharmacoeconomics. ICU. Infection. Pharmacoeconomic studies. Antibiotic policy. Early antibiotic treatment.

Rev Esp Quimioter 2008;21(Núm. Ext. 1):26-34  [pdf]   

New therapeutic options for the treatment of multiresistant bacteria in the ICU

F. Barcenilla Gaite ,  A. Jover Sáenz ,  M. Vallverdú Vidal ,  D. Castellana Perelló 

The number of new antimicrobial drugs in the health care clinical practice has decreased gradually and significantly in the last 15 years. At the same time, there has been an increase in the appearance of microorganisms with resistance to conventional antibiotics, above all in intensive care units (ICU). Within this group, Methicillin-resistant Staphylococcus aureus (MSRA) and methicillin-resistant coagulase- negative staphylococci, vancomycin-resistant enterococci, Pseudomonas aeruginosa and Acinetobacter baumanii resistant to carbapenemics and extended-spectrum ß-lactamase-producing (ESBL) Enterobacteria are the most important. These pathogens are frequently also resistant to other groups of antibiotics such as aminoglycosides, fluoroquinolones and macrolides. New recently introduced antimicrobial agents are available to combat these resistances. These are active mainly against gram positive bacteria resistant strains and in a more timely way against gram negative ones or both. Among the first group, the following stand out: daptomycin (a lipopeptide bactericide for parenteral use) and linezolid (oxazolidinone with bacteriostatic activity for parenteral and oral use). On its part, ertapenem (a carbapenem parenteral bactericide) and tigecyclin (a parenteral bacteriostatic tetracycline) are active against ESBL enterobacteria, the latter also being active against non-fermented gram positives and gram negatives, except for P. aeruginosa. Possibly, the introduction of these new compounds and other futures ones pending introduction will not only improve antimicrobial diversification but also serve to limit the spreading of these microorganisms.

Key words: Multiresistant microorganisms. Daptomycin. Linezolid. Ertapenem. Tigecyclin. Therapeutic strategy.

Rev Esp Quimioter 2008;21(Núm. Ext. 1):9-13 [pdf]