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Rev Esp Quimioter 2019; 32(6): 497-515

Three keys to the appropriate choice of oral antibiotic treatment in the respiratory tract infections  

ROSARIO MENÉNDEZ, RAFAEL CANTÓN, ANDREA GARCÍA-CABALLERO, JOSÉ BARBERÁN

Exacerbation of chronic obstructive pulmonary disease and community-acquired pneumonia are the most frequent infections of the lower respiratory tract in daily clinical practice. Antibiotic selection is a crucial component in its treatment and, in most cases, it is performed empirically. Scientific societies make therapeutic recommendations based on scientific evidence and / or expert recommendations that are of great help to clinicians. Beta-lactams, fluoroquinolones and macrolides are the most commonly used drugs for oral administration. From a practical point of view, there are three keys to the appropriate choice of oral antibiotic treatment, which are the effectiveness, safety and the ecological impact on the patient’s microbiota, including the development of resistance, which will be assessed in depth in this review.

Rev Esp Quimioter 2019; 32(6): 497-515 [Texto completo PDF]


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Rev Esp Quimioter 2020; 33(1):18-23

Development of animal experimental model for bacterial peritonitis

OMAR MONTENEGRO, SOLEDAD ILLESCAS, JOSÉ CARLOS GONZÁLEZ, DAVID PADILLA, PEDRO VILLAREJO, VICTOR BALADRÓN, ROCIO GALÁN, NATALIA BEJARANO, LUCIA MEDINA-PRADO, NATALIA VILLASECA, JOSÉ MANUEL PÉREZ-ORTIZ, JOSÉ RAMÓN MUÑOZ-RODRÍGUEZ, JUAN LUIS SANTIAGO, FRANCISCO JAVIER REDONDO

http://www.doi.org/10.37201/req/064.2019

Objective. The aim of the study was to develop a model of abdominal sepsis in the experimental animal.
Material and methods. Sprague-Dawley male rats of 5 weeks (N=39) were used. Initially, a pilot study (N = 9) was performed and distributed in 3 groups with 1cc inoculum of Escherichia coli ATCC 25922 intraperitoneally at concentrations of 10E8, 10E9 and 10E10 CFU. Subsequently, concentrations of 10E10 CFU are used in two groups of 3 rats with dilutions of 10 cc and 15 cc of distilled water respectively. Finally, a randomized trial of 24 rats was started in three treatment groups after intraperitoneal infection: Group I with physiological serum (N = 6), Group II with ceftriaxone (N = 9), Group III with ceftriaxone plus allicin (N = 9). Microbiological samples of blood and peritoneal fluid were made, as well as histopathological study of intraperitoneal organs (liver, diaphragm and peritoneum).
Results. Death of 100% of the rats infected with 10E10 E. coli UFC concentration with the dilution of 15 ml of distilled water and without antibiotic was oberved. The blood culture and peritoneal fluid culture was positive for the same strain in all of them. The formation of abscesses on the liver surface and polymorphonuclear infiltration in tissues were observed.
Conclusion. The lethal dose of E. coli is 10E10 CFU diluted in 15 cc distilled water by intraperitoneal injection

Rev Esp Quimioter 2020; 33(1):18-23 [Texto completo PDF]

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Rev Esp Quimioter 2020; 33(1):24-31

Adequacy of the special category antibiotics prescriptions in the Emergency Department of a third level urban Hospital

GINA OSORIO, LETICIA FRESCO, ESTER MONCLÚS, MÍRIAM CARBÓ, MAR ORTEGA

http://www.doi.org/10.37201/req/066.2019

Objective. The aim of the study was to analyze the adequacy of the special category antibiotics prescriptions in the Emergency Department (ED) of a third level urban Hospital.
Material and methods. A random sample of 100 different patients who were started with a special category antibiotic along 2018 in the ED was selected. The research team reviewed the medical history of the emergency and admission episode. The independent factors associated with the degree of adequacy of the treatment were determined by logistic regression.
Results. A total of 97 prescriptions were analyzed of which 66 (68%) met the criteria of adequate prescription, 23 (24%) adequate prescription, but with equally recommended alternatives and 8 (8%) were inappropriate prescriptions. The degree of adequacy was 70% if the infection was related to healthcare and 75% if the patient had risk factors for mul-tiresistant (MR) microorganisms’ infection. The percentage of adequacy was higher in the cases in which the focus of the infection (72%) and the severity of the episode (73%) were specified. The independent variables that were associated with an adequate prescription were: the presence of risk factors for MR microorganisms’ infection (OR: 2.35 95% CI: 1.65 – 3.17 p: 0.01), if the focus of the infection (OR: 3.79 95% CI: 1.72 – 4.22 p: 0.02) and the severity of the episode (OR: 3.09 95% CI: 1.12 – 3.09 p: 0.03) were specified.
Conclusions. The prescription of special category antibiotics in ED is appropriate if the clinical guidelines are followed and if the setting of infection acquisition, the risk factors of MR microorganisms, the focus and the severity of infection are taken into account in clinical picture.

Rev Esp Quimioter 2020; 33(1):24-31 [Texto completo PDF]

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Rev Esp Quimioter 2020; 33(1):32-43

Predictive factors of bacteraemia in the patients seen in emergency departments due to infections

SADAF ZAFAR IQBAL-MIRZA, RAQUEL ESTÉVEZ-GONZÁLEZ, VICENTE SERRANO-ROMERO DE ÁVILA, ELENA DE RAFAEL GONZÁLEZ, EVA HEREDERO-GÁLVEZ, AGUSTÍN JULIÁN-JIMÉNEZ

http://www.doi.org/10.37201/req/075.2019

Objectives. The aim of the study was to analyze predictive factors of bacteraemia in patients seen in the emergency department (ED) for an episode of infectious disease.
Patients and methods. Observational, retrospective and descriptive analytical study of all blood cultures extracted in an ED in adult patients (≥ 18 years) seen in ED due to infec-tious disease from 1-1-2019 to 1-7-2019. The follow-up was carried out during 30 days. Thirty-eight variables for predicting bacteraemia were assessed. They covered epidemiological, comorbidity, functional, clinical and analytical factors. Univariate and multivariate logistic regression analysis was performed.
Results. A total of 1,425 blood cultures were finally enrolled in the study. Of those were considered true bacteremia 179 (12.6 %) and as negative blood cultures 1,246 (87.4 %). Amongst negatives, 1,130 (79.3%) without growth and 116 (8.1%) as contaminants blood cultures. Five variables were significantly associated with true bacteraemia: serum procalcitonin (PCT) ≥ 0.51 ng/ml [odds ratio (OR): 4.52; 95% confidence interval (CI): 4.20-4.84, P <.001], temperature > 38.3°C [OR:1.60; 95% CI:1.29-1.90, P <.001], systolic blood pressure (SBP) < 100 mmHg [OR:3.68; 95% CI:2.78-4.58, P <.001], septic shock [OR:2.96; 95% CI:1.78-4.13, P <.001] and malignancy [OR:1.73; 95% CI:1.27-2.20, P <.001].
Conclusions. Several factors evaluated in an initial assessment in the ED, including serum PCT, temperature, hypotension (with/without septic shock) and being malignancy, were found to predict true bacteraemia.

Rev Esp Quimioter 2020; 33(1):32-43 [Texto completo PDF]

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Rev Esp Quimioter 2020; 33(1):1-10

Biomarkers of fungal infection: Expert opinion on the current situation 

EMILIO BOUZA, BENITO ALMIRANTE, JULIO GARCÍA RODRÍGUEZ, JOSÉ GARNACHO-MONTERO, MIGUEL SALAVERT, PATRICIA MUÑOZ, MAURIZIO SANGUINETTI

http://www.doi.org/10.37201/req/2260.2019

The introduction of non-culture-based diagnostic techniques is revolutionizing the world of microbiological diagnosis and infection assessment. Fungi are no exception, and the introduction of biomarkers has opened up enormous expectations for better management of these entities. Biomarkers are diverse, their targets are also diverse and their evaluation has been done preferably in an individualized use and with deficient designs. Less is known about the value of the combined use of biomarkers and the impact of the negativity of two or more biomarkers on antifungal treatment decisions has been poorly studied. Given the paucity of prospective, randomized and definitive studies, we have convened experts from different fields, with an interest in invasive fungal infections, to an-swer some questions about the current relevant use of fungal biomarkers. This document summarizes the answers of these experts to the different questions.

Rev Esp Quimioter 2020; 33(1):1-10 [Full-text PDF]

 

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Rev Esp Quimioter 2019; 32(6): 485-496

HTLV-1 infection: An emerging risk. Pathogenesis, epidemiology, diagnosis and associated diseases 

EMILIANA EUSEBIO-PONCE, EDUARDO ANGUITA, ROBERT PAULINO-RAMIREZ, FRANCISCO JAVIER CANDEL

The Human T-Lymphotropic Virus type 1 (HTLV-1) affects up to 10 million people worldwide. It is directly associated to one of the most aggressive T cell malignancies: Adult T Cell Leukemia-Lymphoma (ATLL) and a progressive neurological disorder, Tropical Spastic Paraparesis/ HTLV-1 Associated Myelopathy (TSP/HAM). Also, infected patients tend to have more severe forms of infectious diseases such as Strongyloidiasis and Tuberculosis. HTLV spreads through parenteral, sexual, and vertical (mother-to-child) routes. Effective viral transmission is produced mainly by cell to cell mechanism, unlike other retroviruses such as HIV, which usually spread infecting cells in a cell-free form. HTLV also has a peculiar distribution, with clusters of high endemicity in nearby areas of very low prevalence or absence of the virus. This could be explained by factors including a possible founder effect, the predominance of mother to child transmission and the cell-to-cell trans-mission mechanisms. More data on viral epidemiology are needed in order to develop strategies in endemic areas aimed at reducing viral dissemination. In this review, we critically analyze HTLV-1 pathogenesis, epidemiology, diagnosis, associated diseases, preventive strategies, and treatments, with emphasis to the emerging risk for Europe and particularly Spain, focusing on prevention methods to avoid viral transmission and associated diseases.

Rev Esp Quimioter 2019; 32(6): 485-496 [Full-text PDF]


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Rev Esp Quimioter 2019; 32(6):525-531

Seroprevalence of measles, mumps, rubella, and varicella zoster virus antibodies among healthcare students: analysis of vaccine efficacy and cost-effectiveness 

İLKER ÖDEMIŞ, ŞÜKRAN KÖSE, İLKAY AKBULUT, HAZAL ALBAYRAK

Introduction. The aims of this study are to determine the seroprevalence for measles, mumps, rubella, and varicella zoster virus (VZV) in a cohort of nursing students, to evaluate vaccination response rates of nonimmune students, and to calculate the cost of vaccinating students based on seroprevalence screening.
Material and methods. A cross-sectional study was conducted August 2015–November 2016 among 326 healthy nursing students aged 14.1–18.1 years. Serum IgG antibodies were measured by ELISA. Results were analyzed by the Chi-square test; a p-value of < 0.05 was considered statistically significant.
Results. The number of seropositive participants (%) was 308 (94.5%) for rubella, 295 (90.5%) for VZV, 244 (74.9%) for measles, and 219 (67.2%) for mumps. A significant correlation was found between measles IgG and age. A relationship was also observed between VZV IgG and kindergarten attendance. Response rates to measles, rubella, VZV, and mumps vaccination were 96%, 92.3%, 87.5%, 78.8%, respectively. The total cost of vaccination after IgG screening was less than vaccination without screening.
Conclusions. In this study, participants’ immunity to measles and VZV was low. Prevaccination serological screening was cost-effectiveness method for preventing measles, mumps, rubella, and varicella infections. We believe that administering booster measles, mumps, and rubella (MMR) vaccine doses or developing a special MMR vaccination strategy for at-risk groups may prevent MMR outbreaks.

Rev Esp Quimioter 2019; 32(6):525-531 [Full-text PDF]



 

 

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Rev Esp Quimioter 2019; 32(6): 516-524

HPV genotype distribution among women with normal and abnormal cervical cytology in Turkey 

TUBA MUDERRIS, ILHAN AFSAR, ASKIN YILDIZ, CEREN AKPINAR VARER

Objectives. The aim of this study was to determine the human papillomavirus (HPV) genotype distribution and to investigate the relationship between HPV genotypes and cervical cytology in women with HPV infection.
Material and methods. In this study, 493 women who were admitted to the obstetrics clinic between 2007 and 2015 years and had HPV positivity were examined retrospectively.
Results. The median age of women included in the study was 37.3 ±10.6. The positivity of single and multiple HPV genotypes was 64.1% and 35.9%, respectively. HPV16 was the most common genotype in women with normal and abnormal cytology. The incidence of atypical squamous cells of undetermined significance (chi-square:8.32 p=0.04) and high-grade squamous intraepithelial lesion (chi-square:13.75 p<0.001) with HPV16 was significantly higher than in other HPV genotypes. In additional, abnormal cytology results in the group 1 (includ-ed HPV16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59) and group 4 (included HPV40, 42, 54, 55, 61, 62, 81, 83, 84) were significantly higher than other groups (chi-square:23.15 p<0.001).
Conclusions. Group 1 genotype ratios were found to be quite high among women with abnormal cytology and women with normal cytology. For this reason, close follow-up is very important in addition to cytological findings along with genotyping, especially from an early age. We were found that multiple HPV infection was not related to the grades of cytological abnormalities. Although abnormal cytology results in group 4 were significantly higher than the other groups, it was not possible to comment on the relationship between these genotypes and cervical cancer since more than one HPV genotype was found in most of these women.

Rev Esp Quimioter 2019; 32(6): 516-524 [Full-text PDF]


 

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Rev Esp Quimioter 2019; 32(6):545-550

Prevalence Among Males From the General Population of Agents Responsible of Not Ulcerative Genital Tract Infections, Assisted in Specialized Care

CARLA FORONDA-GARCÍA-HIDALGO, CARMEN LIÉBANA-MARTOS, BLANCA GUTIÉRREZ-SOTO, MANUELA EXPÓSITO-RUIZ, JOSÉ MARÍA NAVARRO-MARÍ, JOSÉ GUTIÉRREZ-FERNÁNDEZ

Objective. Male genital infections are a major problem due to their high frequency and morbidity and their role in cases of male infertility. We studied the presence, in males assisted in specialized care, of non-ulcerative genital tract infections-producing agents.
Materials and methods. We studied descriptively and retrospective microbiological results of 3,066 samples of male patients, with diagnosis of genital tract infection episode, received between January 1, 2016 and December 31, 2017. Detection of microorganisms in the sample was performed using techniques of artificial culture and PCR (BD-MAX).
Results. Positive results were obtained in 451 samples (14.71%). By culture, the most frequent pathogens were Enterobacterales (18.40%), Enterococcus (13.75%), Haemophilus (8.65%), Neisseria gonorrhoeae (8.43%), Ureaplasma (5.10%), and Candida (3.77%). By polymerase chain reaction (PCR), the most frequent were N. gonorrhoeae (28.37%), Chlamydia trachomatis (26.95%), Ureaplasma urealyticum (17.73%), Mycoplasma hominis/Ureaplasma parvum (10.64%), and Mycoplasma genitalium (7.10%). The age was older in patients infected with Enterobacterales, Candida, or Enterococcus and younger in those infected with N. gonorrhoeae.
Conclusions. N. gonorrhoeae and C. trachomatis are still more common in male genital infection pathogens, although other culturable microorganisms have an important role. These findings demonstrate the importance of systematically applying both conventional culture and PCR techniques for pathogen detection.

Rev Esp Quimioter 2019; 32(6):545-550 [Texto completo PDF]



 

 

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Rev Esp Quimioter 2019; 32(6):539-544

Telemedicine, prison and illness associated with HIV 

ANTONIO BLANCO PORTILLO, GREGORIO PALACIOS GARCÍA-CERVIGÓN, MANUEL PÉREZ FIGUERAS, GEMA NAVARRO JIMÉNEZ, GERMÁN JIMÉNEZ GALÁN, MARÍA VELASCO ARRIBAS, LEONOR MORENO NÚÑEZ, RAFAEL HERVÁS GÓMEZ, ORIOL MARTÍN SEGARRAL, CARLOS GUIJARRO HERRAIZ, ROSA GARCÍA BERRIGUETE, JUAN E LOSA GARCÍA

Objectives. Communicate the activity of telemedicine, from its opening, between a hospital consultation of infectious diseases and a penitentiary center.
Material and methods. Descriptive study of the tele-consultation of infectious diseases of the Alcorcón Foundation University Hospital with the Navalcarnero penitentiary center from 2013 to 2017, which is carried out by videoconference. The reason and number of consultations, diagnosis of HIV, antiretroviral treatment (ART), immunovirological situation, diagnosis of hepatitis C virus (HCV= and intervention performed by the infectious expert were analyzed.
Results. A total of 75 patients were evaluated in a total of 168 consultations (in the first year 11 consultations and in the fifth year 62). The index of successive / new consultations was 1.24 and 85% of the patients required less than 1 year of follow-up. 84% of patients did not move to the hospital. 99% of patients accepted this modality. 96% were HIV positive, 94% of them took ART and 85% had undetectable viral load with 532 CD4/mL of medium. 90% had positive serology for HCV. 72% of the consultations were for the assessment of HCV treatment, which was sofosbuvir/ledipasvir by 63%. 40% changed their ART (70% to avoid interactions).
Conclusion. Most of the evaluated patients have HIV infection. This type of consultation has a growing demand, is efficient (avoids transfers and is decisive) and has high acceptance. The most frequent reason for consultation was the treatment of HCV and more than a third of patients required ART change.

Rev Esp Quimioter 2019; 32(6):539-544 [Texto completo PDF]



 

 

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