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Rev Esp Quimioter 2021; 34(3):249-253

Utility of the blood culture in infection of the urinary tract with fever in the elderly

ELISA ÁLVAREZ ARTERO, AMAIA CAMPO NÚÑEZ, MOISÉS GARCIA BRAVO, INMACULADA GARCÍA GARCÍA, MONCEF BELHASSEN GARCIA, JAVIER PARDO LLEDÍAS

Published: 15 April 2021

http://www.doi.org/10.37201/req/156.2020

Introduction. Urinary tract infections are one of the most common community infections. The diagnosis of urinary infections in the elderly is complex because of its presentation and clinic. The aim of this article is to evaluate the usefulness of blood cultures in febrile urinary tract infection in elderly patients, risk factors, causes of discordance between urine and blood cultures, usefulness of biomarkers and mortality.
Material and methods. Observational study of patients admitted over 65 years old, with urinary infections.
Results. A total of 216 episodes with urinary infections and blood cultures performed. 70 (32,4%) cases with bacteremia.
The most frequently detected isolates in blood cultures were: Escherichia coli 50 (71,4%) and Proteus spp. 6 (8,5%). Only septic shock was associated with a higher frequency of bacteraemia (OR=2,93, IC 95: 1,0-8,5; p=0,04). In 26 of the blood cultures a different isolation of the urine culture was detected. Overall mortality was 9.1%, with no association with the presence of bacteremia (p>0. 05).
Conclusions. One third of elderly people hospitalized by tract urinary infection had bacteremia. Their detection was not associated with overall mortality. Disagree between blood and urine cultures in febrile is frequent, especially in patients with recent antibiotic treatment or recently hospitalized.

Rev Esp Quimioter 2021; 34(3):249-253 [Texto completo PDF]


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Rev Esp Quimioter 2021; 34(3):254-255

Sepsis por Pseudocitrobacter anthropi en un paciente con infección del tracto urinario complicada

ROCÍO CEBOLLADA SÁNCHEZ, MARÍA JOSÉ LAVILLA FERNÁNDEZ, ANA BETRÁN ESCARTÍN, DIEGO ORTEGA LARREA, LUIS TORRES SOPENA

Published: 8 April 2021

http://www.doi.org/10.37201/req/111.2020

LETTER TO THE EDITOR

Rev Esp Quimioter 2021; 34(3):254-255 [Texto completo PDF]


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Rev Esp Quimioter 2021; 34(3):207-213

Usefulness of MALDI-TOF and REP-PCR against PFGE for the epidemiological study of Acinetobacter baumannii

CRISTINA GARCÍA-SALGUERO, ESTHER CULEBRAS, ADELA ALVAREZ-BUYLLA, ICÍAR RODRÍGUEZ-AVIAL, ALBERTO DELGADO-IRIBARREN

Published: 8 April 2021

http://www.doi.org/10.37201/req/142.2020

Objective. To evaluate the ability of MALDI-TOF MS and rep-PCR to discriminate Acinetobacter baumannii clones.
Material and methods. A total of 21 strains of A. baumannii with different epidemiological and phenotipycal characteristics were included in the study. All isolates were analyzed in parallel by MALDI-TOF MS and rep-PCR and the spectra obtained were compared with each other and with the results obtained by pulsed field gel electrophoresis (PFGE). Isolates with a similarity equal to or greater than 87% were considered to be part of the same clonal group.
Results. The analysis of the 21 isolates included in the study, resulted in 8 clonal groups using PFGE, 3 groups by MALDI-TOF MS and 7 groups by rep-PCR analysis. The isolates that formed the different groups by the 3 techniques used were totally different, so it can be concluded that there is no equivalence between the results obtained with the three typing methods used.
Conclusions. Despite its simplicity, neither MALDI-TOF MS nor rep-PCR can at this time replace PFGE for the epidemiological study of A. baumannii.

Rev Esp Quimioter 2021; 34(3):207-213 [Texto completo PDF]


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Rev Esp Quimioter 2021; 34(3):214-219

Evolution of adherence to hand hygiene in health care professionals in a third level hospital in relation to the SARS-CoV-2 pandemic

ALEJANDRO DE ARRIBA-FERNÁNDEZ, MANUEL JESÚS MOLINA-CABRILLANA, LLUÍS SERRA MAJEM

Published: 7 April 2021

http://www.doi.org/10.37201/req/150.2020

Introduction. Proper hand hygiene is the main measure in the prevention and control of infection associated with healthcare. It describes how the pandemic period of 2020 has influenced the evolution of the degree of compliance with hand hygiene practices in health professionals at the Hospital  Universitario Insular de Gran Canaria with respect to previous years.
Methods. Descriptive cross-sectional study of direct observation on compliance with the five moments of hand hygiene in the 2018-2020 period. Adherence is described with the frequency distribution of the different moments in which it was indicated.
Results. Total adherence has increased from 42.5% in 2018, to 47.6% in 2019, and 59.2% in 2020 (p <0.05). Total adherence was greater in the moments after contact with the patient (67%) than in the moments before contact (48%). The area with the highest adherence was dialysis (83%). There is a greater adherence in open areas than in hospitalization areas (65% vs 56%). Higher adherence was determined in physicians (73%) and nurses (74%), than in nursing assistants (50%) (p<0.05).
Conclusions. In 2020 there was an increase in adherence to hand hygiene compared to previous years. A higher percentage of adherence was determined in physicians and nurses than in nursing assistants. We consider that the current SARS-CoV-2 pandemic has played a relevant role in this increase in adherence.

Rev Esp Quimioter 2021; 34(3):214-219 [Full-text PDF]

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Rev Esp Quimioter 2021; 34(3):238-244

Tocilizumab reduces the risk of ICU admission and mortality in patients with SARS-CoV-2 infection

ESTELA MORENO-GARCÍA, VERÓNICA RICO, LAIA ALBIACH, DAIANA AGÜERO, JUAN AMBROSIONI, MARTA BODRO, CELIA CARDOZO, MARIANA CHUMBITA, LORENA DE LA MORA, NICOLE GARCÍA-POUTON, CAROLINA GARCIA-VIDAL, ANA GONZÁLEZ-CORDÓN, MARTA HERNÁNDEZ-MENESES, ALEXY INCIARTE, MONTSE LAGUNO, LORNA LEAL, LAURA LINARES, IRENE MACAYA, FERNANDA MEIRA, JOSEP MENSA, ANTONIO MORENO, LAURA MORATA, PEDRO PUERTA-ALCALDE, JHON ROJAS, MONTSE SOLÁ, BERTA TORRES, MANUEL TORRES, ADRIÀ TOMÉ, MONTSE TUSET, PEDRO CASTRO, SARA FERNÁNDEZ, JOSEP MARIA NICOLÁS, ALEX ALMUEDO-RIERA, JOSE MUÑOZ, MARIANA FERNANDEZ-PITTOL, MARIA ANGELES MARCOS, DOLORS SOY, JOSÉ ANTONIO MARTÍNEZ, FELIPE GARCÍA, ALEX SORIANO

Published: 7 April 2021

http://www.doi.org/10.37201/req/037.2021

Objectives. In some patients the immune response triggered by SARS-CoV-2 is unbalanced, presenting an acute respiratory distress syndrome which in many cases requires intensive care unit (ICU) admission. The limitation of ICU beds has been one of the major burdens in the management around the world; therefore, clinical strategies to avoid ICU admission are needed. We aimed to describe the influence of tocilizumab on the need of transfer to ICU or death in non-critically ill patients.
Material and methods. A retrospective study of 171 patients with SARS-CoV-2 infection that did not qualify as requiring transfer to ICU during the first 24h after admission to a conventional ward, were included. The criteria to receive tocilizumab was radiological impairment, oxygen demand or an increasing of inflammatory parameters, however, the ultimate decision was left to the attending physician judgement. The primary outcome was the need of ICU admission or death whichever came first.
Results. A total of 77 patients received tocilizumab and 94 did not. The tocilizumab group had less ICU admissions (10.3% vs. 27.6%, P=0.005) and need of invasive ventilation (0 vs 13.8%, P=0.001). In the multivariable analysis, tocilizumab remained as a protective variable (OR: 0.03, CI 95%: 0.007-0.1, P=0.0001) of ICU admission or death.
Conclusions. Tocilizumab in early stages of the inflammatory flare could reduce an important number of ICU admissions and mechanical ventilation. The mortality rate of 10.3% among patients receiving tocilizumab appears to be lower than other reports. This is a non-randomized study and the results should be interpreted with caution.

Rev Esp Quimioter 2021; 34(3):238-244 [Full-text PDF]


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Rev Esp Quimioter 2021; 34(3):245-248

Introduction of a complementary screening system for the detection of sexually transmitted infections in patients with sterile pyuria

HELENA GIL-CAMPESINO, LAURA SANTE, ENRIQUE CALLEJAS CASTRO, MARÍA LECUONA

Published: 5 April 2021

http://www.doi.org/10.37201/req/145.2020

Objective. The aim of the study was to evaluate a complementary screening system for the detection of sexually transmitted infections in patients with sterile pyuria.
Material and methods. A prospective study was conducted using Real-time multiplex qPCR in 300 consecutive urine samples with data on sterile pyuria. STI prevalence and patient epidemiological data were analyzed.
Results. A total of 29 positive cases (9.67%) were found: 16 Chlamydia trachomatis, 5 Mycoplasma genitalium, 5 Trichomonas vaginalis and 3 co-infections. The group with sexually transmitted infections was mainly composed of women (65.5%), of which one third was pregnant.
Conclusion. This study presents an effective screening system for the detection of sexually transmitted infections that can be integrated into the laboratories’ work routine.

Rev Esp Quimioter 2021; 34(3):245-248 [Full-text PDF]


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Rev Esp Quimioter 2021; 34(3):259-260

First case of Arcobacter cryaerophilus in paediatric age in Spain

CARLOS RUIZ DE ALEGRÍA PUIG, MARÍA MACHO DÍAZ, JESÚS AGÜERO BALBÍN, JORGE CALVO MONTES

Published: 3 April 2021

http://www.doi.org/10.37201/req/134.2020

LETTER TO THE EDITOR

Rev Esp Quimioter 2021; 34(3):259-260 [Full-text PDF]


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Rev Esp Quimioter 2021; 34(3):267-268

Use of clinical vignettes to screen general practitioners who can participate in a clinical trial about stopping antibiotic treatment when this is no longer necessary

CARLES LLOR, ANA MORAGAS, CAROLINA BAYONA, JOSEP M COTS

Published: 31 March 2021

http://www.doi.org/10.37201/req/001.2021

LETTER TO THE EDITOR

Rev Esp Quimioter 2021; 34(3):267-268 [Full-text PDF] [Supplementary material PDF]


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Rev Esp Quimioter 2021; 34(4): 330-336

Secondary infections in mechanically ventilated patients with COVID-19: An overlooked matter?

ALEJANDRO SUAREZ-DE-LA-RICA, PATRICIA SERRANO, RODRIGO DE-LA-OLIVA, PEDRO SÁNCHEZ-DÍAZ, PILAR MOLINERO, IKER FALCES-ROMERO, CARLOS FERRANDO, JORDI RELLO, EMILIO MASEDA

Published: 23 March 2021

http://www.doi.org/10.37201/req/031.2021

Introduction. The susceptibility to infection probably increases in COVID-19 patients due to a combination of virus and drug-induced immunosuppression. The reported rate of secondary infections was quite low in previous studies. The objectives of our study were to investigate the rate of secondary infections, risk factors for secondary infections and risk factors for mortality in COVID-19 critically ill patients.
Material and methods. We performed a single-center retrospective study in mechanically ventilated critically ill COVID-19 patients admitted to our Critical Care Unit (CCU). We recorded the patients’ demographic data; clinical data; microbiology data and incidence of secondary infection during CCU stay, including ventilator-associated pneumonia (VAP) and nosocomial bacteremia (primary and secondary).
Results. A total of 107 patients with a mean age 62.2 ± 10.6 years were included. Incidence of secondary infection during CCU stay was 43.0% (46 patients), including nosocomial bacteremia (34 patients) and VAP (35 patients). Age was related to development of secondary infection (65.2 ± 7.3 vs. 59.9 ± 12.2 years, p=0.007). Age ≥ 65 years and secondary infection were independent predictors of mortality (OR=2.692, 95% CI 1.068-6.782, p<0.036; and OR=3.658, 95% CI 1.385- 9.660, p=0.009, respectively). The hazard ratio for death within 90 days in the ≥ 65 years group and in patients infected by antimicrobial resistant pathogens was 1.901 (95% CI 1.198- 3.018; p= 0.005 by log-rank test) and 1.787 (95% CI 1.023-3.122; p= 0.036 by log-rank test), respectively.
Conclusions. Our data suggest that the incidence of secondary infection and infection by antimicrobial resistant pathogens is very high in critically ill patients with COVID-19 with a significant impact on prognosis.

Rev Esp Quimioter 2021; 34(4): 330-336 [Full-text PDF]


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Rev Esp Quimioter 2021; 34(3):193-199

Impact of Sepsis Flow Chip, a novelty fast microbiology method, in the treatment of bacteremia caused by Gram-negative bacilli

ESPERANZA MERINO, ADELINA GIMENO, MAR ALCALDE, JAVIER COY, VICENTE BOIX, CARMEN MOLINA-PARDINES, MARIA PAZ VENTERO, ANTONIO GALIANA, ELENA CARO, JUAN CARLOS RODRÍGUEZ

Published: 23 March 2021

http://www.doi.org/10.37201/req/109.2020

Objective. The aim of this study was to assess the impact of the information provided by the new Sepsis Chip Flow system (SFC) and other fast microbiological techniques on the selection of the appropriate antimicrobial treatment by the clinical researchers of an antimicrobial stewardship team.
Methods. Two experienced clinical researchers performed the theoretical exercise of independently selecting the treatment for patients diagnosed by bacteremia due to bacilli gram negative (BGN). At first, the clinicians had only available the clinical characteristics of 74 real patients. Sequentially, information regarding the Gram stain, MALDI-TOF, and SFC from Vitro were provided. Initially, the researchers prescribed an antimicrobial therapy based on the clinical data, later these data were complementing with information from microbiological techniques, and the clinicians made their decisions again.
Results. The data provided by the Gram stain reduced the number of patients prescribed with combined treatments (for clinician 1, from 23 to 7, and for clinician 2, from 28 to 12), but the use of carbapenems remained constant. In line with this, the data obtained by the MALDI-TOF also decreased the combined treatment, and the use of carbapenems remained unchanged. By contrast, the data on antimicrobial resistance provided by the SFC reduced the carbapenems treatment.
Conclusions. From the theoretical model the Gram stain and the MALDI-TOF results achieved a reduction in the combined treatment. However, the new system tested (SFC), due to the resistance mechanism data provided, not only reduced the combined treatment, it also decreased the prescription of the carbapenems.

Rev Esp Quimioter 2021; 34(3):193-199 [Full-text PDF] [Supplementary material PDF ]


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