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Rev Esp Quimioter 2019; 32(6):532-538


Dalbavancin for treating prosthetic joint infections caused by Gram-positive bacteria: A proposal for a low dose strategy. A retrospective cohort study 

LUIS BUZÓN MARTÍN, MARÍA MORA FERNÁNDEZ, JOSE MANUEL PERALES RUIZ, MARIA ORTEGA LAFONT, LEDICIA ÁLVAREZ PAREDES, MIGUEL ÁNGEL MORÁN RODRÍGUEZ, MARÍA FERNÁNDEZ REGUERAS, MARIA ÁNGELES MACHÍN MORÓN, GREGORIA MEJÍAS LOBÓN

Background. Gram-positive bacteria are the leading cause of prosthetic joint infection (PJI). Dalbavancin is a lipoglycopeptide with remarkable pharmacokinetic properties and high bactericidal activity against most Gram-positive bacteria. Although clear evidence regarding its effectiveness in bone and joint infections lacks, recent studies suggest a promising role of dalbavancin in PJI.
Methods. From June 1st 2016 to May 1st 2018, all patients diagnosed of PJI and treated with DAL alone or in combination with other drugs were retrospectively evaluated. Dalbavancin susceptibility of every isolate was studied following CLSI criteria. The primary objective was to assess the clinical efficacy and tolerability of the drug in patients with PJI. A cost-analysis was performed following the DALBUSE study methodology.
Results. Sixteen patients were treated with dalbavancin, eight with total hip arthroplasty infection (THAi) and eight with total knee arthroplasty infection (TKAi). Staphylococcus spp. and Enterococcus spp. were the microorganisms involved. No major side effects were detected. Infection resolved in 12 patients. In 2 patients the treatment failed, and another patient died due to unrelated causes. One patient is currently being treated for hematogenous-spread knee infection secondary to prosthetic aortic arch endocarditis. After discontinuation of dalbavancin, and excluding patients who died or with clinical failure, the median follow up of the cohort was 503 days (interquartile range IQR, 434.5 to 567 days). We calculate that US$ 264,769 were saved.
Conclusion. This study suggests that dalbavancin treatment for PJI caused by Gram-positive bacteria is a safe and effective option that reduces hospital stay and costs. Future reports are needed to confirm these findings.

Rev Esp Quimioter 2019; 32(6):532-538 [Full-text PDF]



 

 

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Rev Esp Quimioter 2019; 32(5):440-444

Hepatitis C: New diagnosis and seroconversions in a Madrid sexually transmitted diseases clinic 

ERIKA ESPERANZA LOZANO RINCÓN, CARMEN RODRÍGUEZ MARTÍN, ÓSKAR AYERDI AGUIRREBENGOA, MAR VERA GARCÍA, REGINO SERRANO HERANZ, JORGE DEL ROMERO GUERRERO

Indroduction. The aim of this study was to evaluate the incidence of new hepatitis C virus (HCV) infections, based on their sexual orientation, human immunodeficiency virus (HIV) status, geographical regions and coinfection with other sexually transmitted diseases (STDs).
Material and methods. This study was carried out at the Sandoval Health Center, reference clinic of Sexually Transmitted Diseases (STDs) in Madrid. All HCV seronegative individuals who were reanalyzed for this virus were included, between January 2010 and December 2016.
Results. A total of 59 new diagnoses of HCV were diagnosed. The proportion of men who have sex with men (MSM) diagnosed with HCV was 37% in 2010 and 75% in 2016 and was even higher in the group of coinfected with HIV/HCV (94%). A total of 67 seroconverters for HCV were detected (1.2%) of which 100% were MSM. The proportion of HCV seroconverters with HIV was 89%.
Conclusions. HCV infection continues to be a current health problem, especially in HIV-positive MSM.

Rev Esp Quimioter 2019; 32(5):440-444 [Texto completo PDF]

 

 

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Rev Esp Quimioter 2019; 32(5):432-439

Vaccine-related adverse reactions in immunocompromised patients and in special situations of a hospital Vaccine Unit 

MARÍA FERNÁNDEZ-PRADA, ANDREA VIEJO-GONZÁLEZ, ALBA MARTÍNEZ-TORRÓN, CARMEN MARTÍNEZ-ORTEGA, JESÚS RUIZ-SALAZAR, ISMAEL HUERTA-GONZÁLEZ

Objectives. The aim of the study was to describe the type of vaccines administered in the Vaccine Unit at a reference hospital. Calculate the overall and specific reporting rate of adverse reactions.
Methods. Retrospective observational study for the period between November 2014 and November 2017, on patients who developed an adverse drug reaction (ADR) after the administration of a vaccine and who were notified to the Spanish Pharmacovigilance System. The variables analyzed were age, sex, risk group, vaccine class, co-administration and type of ADR. A univariate and bivariate analysis was performed. The global and vaccine specific rate of ADR notification was calculated.
Results. A total of 18,123 vaccines were administered, of which 20.7% corresponded to hepatitis B virus vaccine. Fifty-three RAM suspects were reported. In 64.2% of cases only one vaccine was administered. Inactivated vaccines accounted for 88.7% of notifications. The highest number of notifications was generated by the 23 serotypes pneumococcal polysaccharide vaccine. The overall reporting rate was 0.42%. The hexavalent vaccine had the highest reporting rate (2.81%). 49.1% of the ADR were systemic.
Conclusions. The overall reporting rate was low but higher than that of other authors. Proper reporting of possible adverse post-vaccine reactions is essential to contribute to vaccine safety and to increase public confidence in vaccines.

Rev Esp Quimioter 2019; 32(5):432-439 [Texto completo PDF]

 

 

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Rev Esp Quimioter 2019; 32(5):451-457

Historical evolution of the diseases caused by non-pigmented rapidly growing mycobacteria in a University Hospital

MARTA GARCIA-COCA, GRACIELA RODRIGUEZ-SEVILLA, MARIA CARMEN MUÑOZ-EGEA, CONCEPCIÓN PEREZ-JORGE, NEREA CARRASCO-ANTON, JAIME ESTEBAN

Introduction. Non-pigmented rapidly growing mycobacteria (NPRGM) are a group of organisms of increasing interest due to the growing number of potential patients and the difficulties for a proper treatment in many of them. However, the evolution of these diseases in a long period of time and its evolutionary changes has been described only in a scanty number of reports.
Material and methods. We performed a retrospective study between January 1st 2004 and December 31st 2017 in order to evaluate the clinical significance and types of diseases caused by NPRGM. Patients with isolates of NPRGM during this period were selected for the study, and clinical charts were reviewed using a predefined protocol.
Results. During this period we identified 59 patients (76 clinical samples) with isolates of NPRGM, with 12 cases of clinical disease and one patient with doubtful significance (including 6 respiratory tract infections, 2 catheter infections, 1 skin and soft tissue infection, 1 disseminated infection, 1 conjunctivitis, 1 prosthetic joint infection and 1 mastitis). Fifty percent of M. chelonae isolates, 37.5% of M. abscessus isolates and 23.33% of M. fortuitum isolates were clinically significant. None of the isolates of other species were significant.
Conclusions. Most isolates in respiratory samples were contaminants/colonizations. M. abscessus was the main etiological agent in respiratory syndromes, whereas M. chelonae and M. fortuitum were more frequently associated with other infections, especially clinical devices and skin and soft tissue infections.

Rev Esp Quimioter 2019; 32(5):451-457 [Full-text PDF]

 

 

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Rev Esp Quimioter 2019; 32(5):426-431

Biliary microbiote in cholecystectomized patients: Review of empirical antibiotherapy 

MARÍA GIL FORTUÑO, LAURA GRANEL VILLACH, SUSANA SABATER VIDAL, RAQUEL SORIA MARTÍN, DAVID MARTÍNEZ RAMOS, JAVIER ESCRIG SOS, ROSARIO MORENO MUÑOZ, RAFAEL IGUAL ADELL

Introduction. Cholecystitis is an important cause of hospital admission. In moderate or severe cholecystitis, the delay in treatment can lead to serious complications. Our objective is to analyze the microorganisms isolated in bile from cholecystectomized patients and their sensitivity pattern, to evaluate the empirical treatment in those cases in which the surgical removal of the gallbladder should be delayed.
Patients and methods. Prospective descriptive study of biliary cultures of patients undergoing cholecystectomy from May 2013 to February 2015, in the Surgery Department of the Hospital General Universitari de Castelló.
Results. We studied 196 patients, 83 women (42.3%) and 113 men (57.7%), with an average age of 61.5 years. The most used antibiotics as empiric treatment were piperacillin/tazobactam (77.8%) and amoxicillin/clavulanic (14.8%). In 46.4% of patients (91/196) bile cultures were positive. 165 microorganisms were isolated. The majority were Gram-negative bacilli (60.5%), mainly of the Enterobacterales order (91/54.5%), with Escherichia coli being the most frequent microorganism (24%) followed by Klebsiella spp. (12.5%). 3 E. coli with extended-spectrum beta-lactamase (ESBL) and 1 K. pneumoniae with ESBL were isolated. Microorganisms producing carbapenemase and methicillin-resistant Staphylococcus aureus were not isolated.
Conclusion. The bile microbiota, with a predominance of Enterobacterales is similar to that found in european studies.

Rev Esp Quimioter 2019; 32(5):426-431 [Texto completo PDF]

 

 

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Rev Esp Quimioter 2019; 32(5):458-464

Determination of a cutoff value for medication regimen complexity index to predict polypharmacy in HIV+ older patient 

RAMÓN MORILLO-VERDUGO, Mª DE LAS AGUAS ROBUSTILLO-CORTÉS, LAILA ABDEL-KADER MARTÍN, MARÍA ÁLVAREZ DE SOTOMAYOR PAZ, FERNANDO LOZANO DE LEÓN NARANJO, CARMEN VICTORIA ALMEIDA-GONZÁLEZ

Introduction. HIV+ patients have increased their life expectancy with a parallel increase in age-associated co-morbidities and pharmacotherapeutic complexity. The aim of this study was to determine an optimal cutoff value for Medication regimen complexity index (MRCI) to predict polypharmacy in HIV+ older patients
Patients and methods. A transversal observational single cohort study was conducted at a tertiary Hospital in Spain, between January 1st up to December 31st, 2014. Patients included were HIV patients over 50 years of age on active antiretroviral treatment. Prevalence of polypharmacy and it pattern were analyzed. The pharmacotherapy complexity value was calculated through the MRCI. Receiver operating characteristic curve analyses were used to calculate the area under the curve (AUC) for the MRCI value medications to determine the best cutoff value for identifying outcomes including polypharmacy. Sensitivity and specificity were also calculated.
Results. A total of 223 patients were included. A 56.1% of patients had polypharmacy, being extreme polypharmacy in 9.4% of cases. Regarding the pattern of polypharmacy, 78.0% had a cardio-metabolic pattern, 12.0% depressive-psychogeriatric, 8.0% mixed and 2.0% mechanical-thyroidal. The ROC curve demonstrated that a value of medication complexity index of 11.25 point was the best cutoff for predict polypharmacy (AUC=0.931; sensitivity= 77.6%; specificity=91.8%).
Conclusions. A cut-off value of 11.25 for MRCI is proposed to determine if a patient reaches the criterion of polypharmacy. In conclusion, the concept of polypharmacy should include not only the number of prescribed drugs but also the complexity of them.

Rev Esp Quimioter 2019; 32(5):458-464 [Full-text PDF]

 

 

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Rev Esp Quimioter 2019; 32(5):445-450

Concordance between the test of the tuberculin and Interferon Gamma Release Assay-IGRA in patients with immune-mediated inflammatory diseases  

IGNACIO PÉREZ CATALÁN, CELIA ROIG MARTÍ, MARÍA GIL FORTUÑO, PATRICIA TORRENT RAMOS, PALOMA ALBIOL VIÑALS, MARIO CARBALLIDO FERNÁNDEZ, ROSA MARÍA LARREA, CARMEN ORTÍN MARTÍN, JORGE USÓ BLASCO, JOSÉ MANUEL RAMOS RINCÓN

Introduction. The immunosuppressive therapies in the treatment of the immune-mediated inflammatory diseases (EIMI) predispose individuals to the tuberculosis, so the screening of latent tuberculosis infection (ITL) and the treatment reduces the likelihood of a progression to an active tuberculosis. The aim of the study was to analyze the concordance between the test of the tuberculin (PT) and “Interferon Gamma Release Assay-IGRA” in relation to the type of EIMI and the immunosuppressive treatment (IS).
Material and methods. Transversal study of patients with EIMI candidates or in treatment IS forwarded to the ITL screening, from April 2017 until May 2018. The outcome variables were PT and IGRA. The explicative variables were: EIMI, IS, age, gender, prior BCG vaccination and tuberculosis risk factors.
Results. A total of 146 patients were analyzed (33[22.6%] vaccinated with BCG, 1 [0.7%] with a pre-diagnosis of tuberculosis, and 22 [15.1%] from an endemic country). Kappa index (k) was 0,338 between PT and IGRA for the whole sample. A lower concordance was found in patients with the Crohn’s disease (k=0.125), in the ones treated with corticosteroids (k=0.222), vaccinated with BCG (k=0.122) and in patients from tuberculosis endemic countries (k=0.128).
Conclusion. The concordance between PT and IGRA is affected in patients with EIMI, and to a greater extent to patients with the inflammatory bowel disease, with the corticotherapy, with the BCG vaccination, or in the ones from endemic countries.

Rev Esp Quimioter 2019; 32(5):445-450 [Texto completo PDF]

 

 

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Rev Esp Quimioter 2019; 32(5):465-468

In vitro study of synergy of ampicillin with ceftriaxone against Listeria monocytogenes 

JOSÉ ANTONIO LEPE, ÁNGEL RODRÍGUEZ-VILLODRES, GUILLERMO MARTÍN-GUTIÉRREZ, RAFAEL LUQUE, JAVIER AZNAR

Objectives. To evaluate if the in vitro activity of ampicillin increases when combined with ceftriaxone.
Material and methods. The activity of ampicillin and ceftriaxone was evaluated against six Listeria monocytogenes invasive clinical isolates. Ampicillin and ceftriaxone MICs were determined by the broth microdilution method. Synergy was evaluated by checkerboard and time-kill curves methods.
Results. All six L. monocytogenes strains were susceptible to ampicillin (MICs 0.25-0.5 mg/L). A bacteriostatic synergy was demonstrated by the FIC index of 0.5 and a 2.5 log10 CFU reduction on the six strains studied for MIC ampicillin plus 16 mg/L ceftriaxone concentrations.
Conclusions. The association of ceftriaxone with ampicillin increases the in vitro activity of ampicillin, and therefore could be a valuable option in the treatment of invasive infection by L. monocytogenes.

Rev Esp Quimioter 2019; 32(5):465-468 [Full-text PDF]

 

 

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Rev Esp Quimioter 2019; 32(5):410-425

Clinical practice update of antifungal prophylaxis in immunocompromised children 

JOSÉ TOMÁS RAMOS, CONCEPCIÓN ALBA ROMERO, SYLVIA BELDA, FRANCISCO JAVIER CANDEL, BEGOÑA CARAZO GALLEGO, AURORA FERNÁNDEZ-POLO, LAURA FERRERAS ANTOLÍN, CARMEN GARRIDO COLINO, MARÍA LUISA NAVARRO, OLAF NETH, PETER OLBRICH, ELENA RINCÓN-LÓPEZ, JESÚS RUIZ CONTRERAS, PERE SOLER-PALACÍN, ON BEHALF OF THE FUNGAL INFECTION STUDY GROUP OF SPANISH SOCIETY OF PAEDIATRIC INFECTIOUS DISEASE (SEIP); TRASLATIONAL RESEARCH NETWORK IN PEDIATRIC INFECTIOUS DISEASES (RITIP)

Due to the rise in the number and types of immunosuppressed patients, invasive fungal infections (IFI) are an increasing and major cause of morbidity and mortality in immunocompromised adults and children. There is a broad group of pediatric patients at risk for IFI in whom primary and/or secondary antifungal prophylaxis (AFP) should be considered despite scant evidence. Pediatric groups at risk for IFI includes extremely premature infants in some settings, while in high-risk children with cancer receiving chemotherapy or undergoing haematopoietic stem cell transplantation (HCT), AFP against yeast and moulds is usually recommended. For solid organ transplanted, children, prophylaxis depends on the type of transplant and associated risk factors. In children with primary or acquired immunodeficiency such as HIV or long-term immunosuppressive treatment, AFP depends on the type of immunodeficiency and the degree of immunosuppression. Chronic granulomatous disease is associated with a particular high-risk of IFI and anti-mould prophylaxis is always indicated. In contrast, AFP is not generally recommended in children with long stay in intensive care units. The choice of AFP is limited by the approval of antifungal agents in different age groups and by their pharmacokinetics characteristics. This document aims to review current available information on AFP in children and to provide a comprehensive proposal for each type of patient.

Rev Esp Quimioter 2019; 32(5):410-425 [Full-text PDF]

 

 

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Rev Esp Quimioter 2019; 32(Suppl. 2):69-72

Infection in the process of organ donation  

OSCAR LEN ABAD

The difference between demand and supply has led transplant organizations to look for marginal donors, including those who could transmit infections to their recipients. This potential risk must be thoroughly evaluated to optimize the use of such organs without increasing the incidence of graft dysfunction and the morbidity and mortality of the recipient. This article aims to provide a general and up-to-date overview of this issue.

Rev Esp Quimioter 2019; 32(Suppl. 2):69-72 [Full-text PDF]

 

 

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