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Rev Esp Quimioter 2022; 35(2):178-191

Impact of the implementation of a Sepsis Code Program in medical patient management: a cohort study in an Internal Medicine ward

AZUCENA BAUTISTA HERNÁNDEZ, ENRIQUE DE VEGA-RÍOS, JORGE SERRANO BALLESTEROS, DANIEL USEROS BRAÑA, LAURA CARDEÑOSO DOMINGO, ANGELS FIGUEROLA TEJERINA, ANDRÉS VON WERNITZ TELEKI, DAVID JIMÉNEZ JIMÉNEZ, IGNACIO DE LOS SANTOS GIL, CARMEN SÁEZ BÉJAR

Published: 31 January 2022

http://www.doi.org/10.37201/req/132.2021

Introduction. Sepsis is the main cause of death in hospitals and the implementation of diagnosis and treatment bundles has shown to improve its evolution. However, there is a lack of evidence about patients attended in conventional units.
Methods. A 3-year retrospective cohort study was conducted. Patients hospitalized in Internal Medicine units with
sepsis were included and assigned to two cohorts according to Sepsis Code (SC) activation (group A) or not (B). Baseline and evolution variables were collected.
Results. A total of 653 patients were included. In 296 cases SC was activated. Mean age was 81.43 years, median Charlson comorbidity index (CCI) was 2 and 63.25% showed some functional disability. More bundles were completed in group A: blood cultures 95.2% vs 72.5% (p < 0.001), extended spectrum antibiotics 59.1% vs 41.4% (p < 0.001), fluid resuscitation 96.62% vs 80.95% (p < 0.001). Infection control at 72 hours was quite higher in group A (81.42% vs 55.18%, odds ratio 3.55 [2.48-5.09]). Antibiotic was optimized more frequently in group A (60.77% vs 47.03%, p 0.008). Mean in-hospital stay was 10.63 days (11.44 vs 8.53 days, p < 0.001). Complications during hospitalization appeared in 51.76% of patients, especially in group B (45.95% vs 56.58%, odds ratio 1.53 [1.12-2.09]). Hospital readmissions were higher in group A (40% vs 24.76%, p < 0.001). 28-day mortality was significantly lower in group A (20.95% vs 42.86%, odds ratio 0.33 [0.23-0.47]).
Conclusions. Implementation of SC seems to be effective in improving short-term outcomes in IM patients, although therapy should be tailored in an individual basis.

Rev Esp Quimioter 2022; 35(2):178-191 [Full-text PDF]


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Rev Esp Quimioter 2022; 35(2):171-177

Methicillin-resistant Staphylococcus epidermidis infectious keratitis: Clinical and microbiological profile

LOURDES VIDAL OLIVER, PATRICIA BAYO CALDUCH, LORENA FORQUÉ RODRÍGUEZ, DAVID NAVARRO ORTEGA, ANTONIO MIGUEL DUCH SAMPER, JAVIER COLOMINA RODRÍGUEZ

Published: 24 January 2022

http://www.doi.org/10.37201/req/128.2021

Introduction. Staphylococcus epidermidis (SE) is a common cause of bacterial keratitis in certain geographic areas. A high percentage of resistance to methicillin is shown, which gives it cross resistance to beta-lactams and sometimes resistance to other antibacterial groups. We analyzed clinical and microbiological variables in patients with infectious keratitis due to SE.
Methods. Medical records of 43 patients with suspected infectious keratitis and microbiological confirmation for SE, between October 2017 and October 2020, were retrospectively studied. Clinical characteristics (risk factors, size of lesions, treatment, evolution) and microbiological (susceptibility to antibiotics) were analyzed, and groups of patients with methicillin-resistant (MRSE) and methicillin-susceptible (MSSE) infection were compared.
Results. MRSE was present in 37.2% of infectious keratitis. All isolates were sensitive to vancomycin and linezolid. Rates of resistance to tetracyclines and ciprofloxacin were 50% and 56% in the MRSE group, and 11% and 7% in the MSSE group. The clinical characteristics, including size of lesion, visual axis involvement, inflammation of anterior chamber, presence of risk factors and follow-up time, did not show statistically significant differences between groups.
Conclusions. MRSE is a common cause of infectious keratitis caused by SE and shows a high rate of multidrug resistance. Clinically, it does not differ from MSSE keratitis. Additional work is needed to confirm these findings.

Rev Esp Quimioter 2022; 35(2):171-177 [Full-text PDF]


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Rev Esp Quimioter 2022; 35(1):16-29

Decalogue for the selection of oral antibiotics for lower respiratory tract infections

RAFAEL CANTÓN, JOSÉ BARBERÁN, MANUEL LINARES, JOSÉ MARÍA MOLERO, JOSÉ MIGUEL RODRÍGUEZ-GONZÁLEZ-MORO, MIGUEL SALAVERT, JUAN GONZÁLEZ DEL CASTILLO

Published: 19 January 2022

http://www.doi.org/10.37201/req/172.2021

Lower respiratory tract infections, including chronic obstructive pulmonary disease exacerbations (COPD-E) and community acquired pneumonia (CAP), are one of the most frequent reasons for consultation in primary care and hospital emergency departments, and are the cause of a high prescription of antimicrobial agents. The selection of the most appropriate oral antibiotic treatment is based on different aspects and includes to first consider a bacterial aetiology and not a viral infection, to know the bacterial pathogen that most frequently cause these infections and the frequency of their local antimicrobial resistance. Treatment should also be prescribed quickly and antibiotics should be selected among those with a quicker mode of action, achieving the greatest effect in the shortest time and with the fewest adverse effects (toxicity, interactions, resistance and/or ecological impact). Whenever possible, antimicrobials should be rotated and diversified and switched to the oral route as soon as possible. With these premises, the oral treatment guidelines for mild or moderate COPD-E and CAP in Spain include as first options beta-lactam antibiotics (amoxicillin and amoxicillin-clavulanate and cefditoren), in certain situations associated with a macrolide, and relegating fluoroquinolones as an alternative, except in cases where the presence of Pseudomonas aeruginosa is suspected.

Rev Esp Quimioter 2022; 35(1):16-29 [Full-text PDF] [Texto completo – PDF]


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Rev Esp Quimioter 2022; 35(2):165-170

Sonication did not provide reliability to Maki technique for catheter related bloodstream infection diagnosis

LEONARDO LORENTE, MARÍA LECUONA, ALEJANDRA PÉREZ-LLOMBET, ADRIANA GONZÁLEZ-MESA, MANUEL CALLEJÓN, TERESA DELGADO MELIAN, INÉS OLAYA GARCIA, ALEJANDRO JIMÉNEZ, MARÍA LUISA MORA, ANA MADUEÑO

Published: 17 January 2022

http://www.doi.org/10.37201/req/110.2021

Objective. The aim of our study was to analyze sonication and Maki techniques for diagnosis of catheter tip colonization and catheter-related bloodstream infection (CRBSI) on patients admitted to ICU.
Material and methods. Observational and prospective study in one Intensive Care Unit. Patients with some central venous catheter (CVC) at least for 7 days and catheter-related infection (CRI) suspicion (new episode of fever or sepsis) were included. We performed Maki technique followed by sonication of catheter tip. We compared area under the curve (AUC) of Maki, sonication, and techniques combination to diagnosis catheter tip colonization and CRBSI.
Results. We included 94 CVC from 87 CRI suspicion episodes. We found 14 cases of catheter tip colonization and 10 cases of CRBSI. Of the 14 catheter tip colonization cases, 7 (50.0%) were detected by Maki and sonication techniques, 6 (42.9%) were detected only by Maki technique, and 1 (7.1%) was detected only by sonication technique. Of the 10 CRBSI, 6 (60.0%) were detected by Maki and sonication techniques, 4 (40.0%) were detected only by Maki technique, and any only by sonication technique. We found higher AUC in Maki technique than in sonication technique to diagnosis of CRBSI (p=0.02) and to diagnosis of catheter tip colonization (p=0.03). No significant differences were found in AUC between Maki technique and combination techniques for diagnosis of catheter tip colonization (p=0.32) and of CRBSI (p=0.32).
Conclusion. Sonication did not provide reliability to Maki technique for diagnosis of catheter tip colonization and CRBSI.

Rev Esp Quimioter 2022; 35(2):165-170 [Full-text PDF]


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Rev Esp Quimioter 2022; 35(2):157-164

Prevalence of SARS-CoV-2 infection during the first wave of the pandemic among health and non-health personnel of the General Hospital of Segovia, Castilla y León

CARLOS AVELLANEDA MARTÍNEZ, JULIO CÉSAR SANTOS PASTOR, ISABEL MARÍA MARCOS SÁNCHEZ, AINHOA NARROS GIMÉNEZ, MARÍA GUTIÉRREZ DE ANTÓN, PABLO ALONSO CHACÓN

Published: 17 January 2022

http://www.doi.org/10.37201/req/094.2021

Introduction. Health and non-health workers (H&NH-W) in a hospital are more exposed to SARS-CoV-2 infection than the general population. We studied the prevalence of this infection in these workers of Segovia´s Hospital after the first epidemic wave.
Material and methods. Monocentric, observational, cross-sectional study, carried out between April 29 and May 14, 2020. The infection was diagnosed by capillary immunochromatography test for IgG and / or IgM antibodies, or PCR. Work, health, and exposure variables were studied.
Results. A total of 1,335 H&NH-W participated in the study out of a total of 1,667 (80.1%), 79.3% women, with a mean age of 47.3 years, and 47.1 for men. The prevalence of infected was 21.95%, 24.7% asymptomatic. Age presented a significant OR of 1.02/year. Exposure outside of work increased the prevalence by 16.8%. The continued use of Personal Protective Equipment (PPE) and the administration of nebulizations presented an OR of 0.54 and 0.46 respectively. The symptoms associated with the highest prevalence were anosmia (OR 9.31), ageusia (OR 3.05), and fever (OR 1.94). Today, about 75% of H&NH-W were infected in the first wave.
Conclusions. The prevalence is higher among healthcare workers than the population they serve. Age is associated with a higher prevalence of infection. Almost a quarter of those infected were asymptomatic. The continuous use of PPE was associated with a lower prevalence, for that the administration of nebulisations could be safe. The symptoms with the greatest association were fever, anosmia, and ageusia.

Rev Esp Quimioter 2022; 35(2):157-164 [Texto completo PDF]


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Rev Esp Quimioter 2022; 35(2):131-156

Past and future of HIV infection. A document based on expert opinion

EMILIO BOUZA, JOSÉ RAMÓN ARRIBAS, BELÉN ALEJOS, JOSÉ IGNACIO BERNARDINO, MAYE COIRAS, PEP COLL, JORGE DEL ROMERO, MARÍA JOSÉ FUSTER, MIGUEL GÓRGOLAS, ALIPIO GUTIÉRREZ, DIEGO GRACIA, VICTORIA HERNANDO, JAVIER MARTÍNEZ-PICADO, JOSÉ MANUEL MARTÍNEZ SESMERO, ESTEBAN MARTÍNEZ, SANTIAGO MORENO, BEATRIZ MOTHE, MARIA LUISA NAVARRO, DANIEL PODZAMCZER, FEDERICO PULIDO, JOSÉ TOMÁS RAMOS, EZEQUIEL RUIZ-MATEOS, INÉS SUÁREZ GARCÍA, ESTEBAN PALOMO

Published: 12 January 2022

http://www.doi.org/10.37201/req/083.2021

HIV infection is now almost 40 years old. In this time, along with the catastrophe and tragedy that it has entailed, it has also represented the capacity of modern society to take on a challenge of this magnitude and to transform an almost uniformly lethal disease into a chronic illness, compatible with a practically normal personal and relationship life. This anniversary seemed an ideal moment to pause and reflect on the future of HIV infection, the challenges that remain to be addressed and the prospects for the immediate future. This reflection has to go beyond merely technical approaches, by specialized professionals, to also address social and ethical aspects. For this reason, the Health Sciences Foundation convened a group of experts in different aspects of this disease to discuss a series of questions that seemed pertinent to all those present. Each question was presented by one of the participants and discussed by the group. The document we offer is the result of this reflection.

Rev Esp Quimioter 2022; 35(2):131-156 [Full-text PDF]


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Rev Esp Quimioter 2022; 35(1):80-83

Impact of SARS-COV-2 on the diagnosis of community bacteremia in a tertiary hospital

SARAY MORMENEO BAYO, MIGUEL MORENO HIJAZO, MARÍA PILAR PALACIÁN RUÍZ, MARÍA CRUZ VILLUENDAS USÓN

Published: 5 January 2022

http://www.doi.org/10.37201/req/104.2021

Objective. We carry out an analysis of the bacteremia diagnosed in the Emergency Department during 2020, coinciding with the period of the pandemic.
Method. We performed a retrospective analysis from March 4, 2020 to December 31, 2020.
Results. The number of patients who went to the Emergency Department during the study period and the number of extracted blood cultures decreased by 46.79% and 35.7% compared to the same period in 2019 (p <0.05). 320 bacteremia occurred while 507 occurred in 2019, assuming a decrease of 36.8% (p <0.05). The positivity rate of blood cultures was 7.09% in 2020 and 7.23% in 2019 and the contamination rate was 7.07 % in 2020 and 5.67% in 2019. The most frequently isolated microorganism was Escherichia coli, followed by Staphylococcus aureus and Klebsiella pneumoniae. A 6.62% of the isolated E. coli were carriers of extended-spectrum beta-lactamases (ESBL). The percentage of methicillin-resistant S. aureus was 12.9 % and that of K. pneumoniae ESBL was 11.54%.
Conclusion. During the SARS-CoV-2 pandemic there has been a decrease in the number of bacteremia diagnoses, it is possible that attention was focused especially on COVID, forgetting other diseases, such as bacteremia.

Rev Esp Quimioter 2022; 35(1):80-83 [Texto completo PDF]


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Rev Esp Quimioter 2022; 35(1):103-104

Rendimiento del ensayo de amplificación mediada por transcriptasa (TMA) Procleix SARS-CoV-2 para el diagnóstico de COVID-19 en “pools” de muestras nasofaríngeas. Pequeño estudio piloto 

MARTA PÉREZ-ABELEDO, BELÉN RAMOS, FRANCISCO JAVIER CANDEL, JUAN CARLOS SANZ

Published: 26 December 2021

LETTER TO THE EDITOR

http://www.doi.org/10.37201/req/101.2021

Rev Esp Quimioter 2022; 35(1):103-104 [Texto completo PDF]


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Rev Esp Quimioter 2022; 35(1):76-79

Mycoplasma genitalium and sexually transmitted infections: evidences and figures in a tertiary hospital

GLORIA MARTÍN-SACO, ALEXANDER TRISTANCHO, ANTONINA ARIAS, ISABEL FERRER, ANA MILAGRO, JUAN M. GARCÍA-LECHUZ

Published: 17 December 2021

http://www.doi.org/10.37201/req/091.2021

Introduction. Mycoplasma genitalium is an emerging cause of sexually transmitted infections (STIs) and has been implicated in non-gonococcal urethritis in men and cervicitis in woman. The aim of this study is determinate the incidence and pathogenicity of M. genitalium within the diagnosis of STIs detected from clinical samples in a third level hospital.
Material and methods. A total of 8,473 samples from endocervix, urethra, vagina, rectum and others were processed applying Allpex STI Essential Assay. More than 190 records were reviewed to determinate M. genitalium pathogenicity.
Results. M. genitalium was detected in a rate 2.8%. Co-infections were detected in 20% of the patients.
Conclusions. M. genitalium is considered a STI emerging pathogen thanks to the renewal of multiplex-PCR tests although with a low incidence in our approach. Emerging from our experience and the institutional recommendations both detection of acid nucleic techniques (NAATs) and gonococcal culture might be implemented accurately and coexist to adequate prescriptions.

Rev Esp Quimioter 2022; 35(1):76-79 [Full-text PDF]


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Rev Esp Quimioter 2022; 35(2):204-212

Putative Secondary Structure at 5’UTR as a Potential Antiviral Target against SARS-CoV-2

EMILIO GARCIA-MORAN, MARTA HERNÁNDEZ, DAVID ABAD, JOSÉ M. EIROS

Published: 15 December 2021

http://www.doi.org/10.37201/req/153.2021

SARS-CoV-2 is an enveloped positive-sense single-stranded RNA coronavirus that causes COVID-19, of which the current outbreak has resulted in a high number of cases and fatalities throughout the world, even vaccine doses are being administered. The aim of this work was to scan the SARS-CoV-2 genome in search for therapeutic targets. We found a sequence in the 5’UTR (NC\_045512:74-130), consisting of a typical heptamer next to a structured region that may cause ribosomal frameshifting. The potential biological value of this region is relevant through its low similarity with other viruses, including coronaviruses related to SARS-CoV, and its high sequence conservation within multiple SARS-CoV-2 isolates. We have predicted the secondary structure of the region by means of different bioinformatic tools. We have suggested a most probable secondary structure to proceed with a 3D reconstruction of the structured segment. Finally, we carried out virtual docking on the 3D structure to look for a binding site and then for drug ligands from a database of lead compounds. Several molecules that could be probably administered as oral drugs show promising binding affinity within the structured region, and so it could be possible interfere its potential regulatory role.

Rev Esp Quimioter 2022; 35(2):204-212 [Full-text PDF]


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