Epidemiological aspects of mycosis in the critical patient

J. Pemán García 

  

Fungemia, generally causes by Candida spp., is the most frequent deep mycoses in the critical patient and is many times clinically undistinguishable from bacterial septicemia. Less frequently, respiratory or disseminated mycosis produced by Aspergillus or other filamentous fungi, such as Scedosporium, Fusarium, Pneumocystis, Acremonium or zygomycetes have been described. Currently, invasive candidiasis is the fourth cause of nosocomial infection in Europe and the USA. Furthermore, in the SCOPE study, Candida is the third microorganism isolated from the blood culture in the ICU and the mortality that can be attributed to it reaches 25 %-38 %. Currently, the incidence of candidemia has been estimated to be 2 cases per every 1,000 admissions in the mixed critical units and 9.9 cases in the critical surgical units. On its part, invasive aspergillosis is observed in 1.25 % of the patients admitted to the ICU and mostly affects patients with chronic bronchopathy treated with glucocorticoids. It is considered as an indicator of bad prognosis and is associated to very high mortality rates (40%-100 %).

 

Key words:  UCI. Candidemia. Fungemia. Aspergillosis.

Rev Esp Quimioter 2008;21(Núm. Ext. 1):7-8 [pdf] 

Guidelines for the treatment on infections caused by methicillin-resistant Staphylococcus aureus

J. Mensa ,  J. Barberán ,  P. Llinares ,  J.J. Picazo ,  E. Bouza ,  F. Álvarez-Lerma ,  M. Borges Sá ,  R. Serrano ,  C. León ,  Xavier Guirao Garriga ,  J Arias ,  E Carreras ,  M Sanz ,  J. Á. García Rodríguez 

  

Infections due to methicillin-resistant Staphylococcus aureus (MRSA) have undergone important changes in the last five years that have influenced the choice of therapy: i) increase of their frequency in hospital-associated settings and, more recently, in community settings; ii) better knowledge of clinical implications of the pharmacokinetic and pharmacodynamic properties of vancomycin; iii) improvement of current standard methods for rapid detection of MRSA in clinical samples; iv) clear evidence that vancomycin is losing efficacy against MRSA with MIC > 1 μg/mL; and v) appearance of new antibiotics suitable for use in these infections (linezolid, daptomycin, tigecyclin). Under this situation guidelines for the treatment of common infections caused by MRSA appear to be necessary to improve the efficacy and reduce the mortality.

 

Key words: Methicillin-resistant S. aureus (MRSA). MRSA guidelines. New antibiotics.

Rev Esp Quimioter 2008;21(4):234-258 [pdf] 

Staphylococcus aureus bacteremia in Castellón General Hospital (2001-2005)

S. Sabater Vidal ,  R. Moreno Muñoz 

  

Objective. The aim of this study was to know the frequency of bacteremias produced by Staphylococcus aureus and the sensibility that strains showed, as well as the clinical characteristics of the patients.

Method. We retrospectively studied cases of S. aureus bacteremia detected in our hospital from 2001 to 2005 and also reviewed medical histories from patients during 2005.

Results. A total of 295 cases of S. aureus bacteremia were detected in this study. Annual distributions of the cases were as follows: 35, 54, 62, 64 and 80. By gender, 62.7 % related to males and 37.3 % to females. A total of 58.6 % of the patients were admitted to medical services and 49 % were older than 65 years. Regarding resistance, 34 % of the strains showed resistance to oxacillin, 33 % to ciprofloxacin, 41 % to erythromycin and 4.4 % to gentamicin. In one-third of the patients, S. aureus was isolated in other samples, the catheter being the most common. A total of the 73.5 % of the patients had some baseline disease and the most frequent predisposing factor was the intravascular catheter. The bacteremias were nosocomial-acquired in 73.5 % of the cases.

Conclusions. In our hospital, S. aureus bacteremia and oxacillin resistance has been increasing over the years of this study.    

 

Key words: Staphylococcus aureus. Bacteremia. Oxacillin resistance. Catheter. Nosocomial.   

 

Rev Esp Quimioter 2008;21(4):217-223 [pdf]

A day in Spanish microbiology. Descriptive study of the activity of the clinical microbiology departments

J. Prieto ,  J. Á. García Rodríguez ,  J. Barberán ,  J. J. Granizo ,  M. P. Rodicio ,  J. González     

Introduction. The laboratory is an essential part of the work in the Clinical Microbiology Department. This study has aimed to measure the activity of these laboratories.

Material and methods. A survey was self-administered on the activity occurring during one work day by each hospital in October 2007.

Results. Thirty six hospitals reported 14,076 tests. Serology was the most frequently reported test (30.3%) followed by urine culture (27.8 %), blood tests (13.2 %), respiratory tract samples (8%), feces (7.1%), urethral (5.8%), skin (5.3%) and cerebrospinal fluid (2.6%). According to species, 73.2% of the isolates were bacteria (22.9 % were positive), 8.9% were virus (17% positive), fungi 8.1% (25.2% positive), and 5.5% mycobacterias (5.9% were positive) and parasite 4.5% (12.5% positive). Susceptibility test were performed by automatic methods (62.3%) followed by diffusion test (27.1%) and E-test (9.1%). A total of 5.6% of the susceptibility tests showed in vitro resistance to antibiotics. Fungi were identified in 108 isolates. Candida and Aspergillus were the most frequent genus (85.1% and 8.3%, respectively). Origins of the samples were: lower respiratory tract (32.4 %), genital tract (24.1 %), urine (10.2 %), blood (10.2 %) and skin (10.2 %). Twelve identification techniques were used, the most frequent being the morphological test (54.8%) and biochemical test (39.7%). Broken down by departments, 20.4% were sent from the ICU, 16.7% from surgery, 29.6% from medicine and 18.5% from primary care.

Discussion. Although the workload of the laboratories has been measured in this work, aspects such as specimen manipulation, clinical advice and research were not considered.

  

Key words: Laboratory. Fungi. Activity. Assistance. Organization.

Rev Esp Quimioter 2008;21(4):206-212 [pdf]  

Antimicrobial drugs errors: the silent epidemic in patient safety

M. D. Menéndez Fraga ,  J. J. Corte García ,  M. Alonso Álvarez ,  M. Espín Fernández ,  J. Solano Jaurrieta. ,  F. Vázquez Valdés 

  

Introduction. Prescribed drugs and the mistakes in the administration to patient is the first cause of adverse events in the hospitals. The aim of this study has been to evaluate antimicrobial drug mistakes in one of our hospital wards in a two year period 2005 and 2006.

Methods. All the errors were reported through the National Health Service IR2 form (England) on a voluntary basis and classified by means of process, type of errors, their causes and contributory factors, as well as the severity. We analyzed the economic costs.    

Results. A 1.3% of the inpatients had an antimicrobial error in the administration to the patient (0.84 by 1,000 prescribing orders). Classified by processes, the administration (32.4%) and dispensation (44.1%) were the most frequent errors. By type of error: the erroneous medication (32.4%), the main root cause the human factors (58.8 %) and the contribution factor due to design of tasks (55.9 %). The 5.9% of errors were severe events, mainly in the group of the betalactamic drugs, and mainly by parenteral administration (50%).

Conclusions. Antimicrobial drug errors, frequent and sometimes severe, suppose a silent epidemic not being detected without the patient safety methodology. They represent a high cost for a hospital.

  

Key words: Medication errors. Antimicrobial drugs. Patient safety.

Rev Esp Quimioter 2008;21(3):194-197 [pdf]