,

Rev Esp Quimioter 2019; 32(Suppl.1):01-07


New perspectives for reassessing fosfomycin: applicability in current clinical practice

FRANCISCO JAVIER CANDEL, MAYRA MATESANZ DAVID, JOSÉ BARBERÁN LÓPEZ

Fosfomycin is a bactericidal antibiotic that interferes with cell wall synthesis. The drug therefore has a broad spectrum of activity against a wide range of Gram-positive and Gram-negative bacteria. Both the European Medicines Agency (EMA) and the US Food and Drug Administration (FDA) have started review processes of the accumulated information on the use of fosfomycin and on information from new clinical trials. The intent is to establish usage terms in Europe and to authorize the sale of fosfomycin in the US. This monograph reviews the most current aspects of the compound. From the microbiological point of view, fosfomycin’s single mechanism of action can provide a synergistic effect to other classes of antibiotics, including β-lactams, aminoglycosides, lipopeptides and fluoroquinolones. The resistance mechanisms include the reduced intracellular transport of the antibiotic, the change in target and the direct inactivation of the antibiotic by metalloenzymes and kinases; however, the clinical impact of some of these mechanisms has not yet been elucidated. The lack of agreement in determining the sensitivity cutoffs between the Clinical and Laboratory Standards Institute (CLSI) (≤64 mg/L) and the European Committee on Antimicrobial Susceptibility Testing (EUCAST) (≤32 mg/L), the fact that a number of microorganisms require a higher MIC (Klebsiella spp., Enterobacter spp., Serratia spp., Pseudomonas aeruginosa) and the drug’s different effective concentrations against Gram-positive and Gram-negative bacteria have resulted in recommended dosages for treating multiresistant microorganism infections that vary between 8 and 12 g/day for Gram-positive bacteria and 16 and 24 g/day for Gram-negative bacteria. Fosfomycin has 3 presentations (intravenous with disodium salt, oral with calcium salt and combined with tromethamine),has good distribution in tissues and abscesses and is well tolerated. The pharmacodynamic ratio of dosage production for fosfomycin is AUC/MIC. However, the pharmacokinetics/pharmacodynamic ratio could be optimized in daily practice based on the pathogen, the patient’s clinical profile or the infection model. Fosfomycin is the treatment of choice for cystitis in immunocompetent patients, patients with transplants, pregnant women and in pediatric settings. The drug is especially useful due to its microbiological activity and oral posology in cystitis caused by ESBL bacteria. Administer intravenously at high doses and combined with other antimicrobial agents. Fosfomycin has been useful in treating infections by multiresistant Gram-negative bacteria, such as Enterobacteriaceae, carbapenemase carriers and P. aeruginosa, extensively resistant or panresistant in urinary infections and in skin and soft tissue. Fosfomycin has also been shown active in combination with daptomycin or imipenem in osteoarticular infections by methicillin-resistant Staphylococcus aureus. Fosfomycin is an old antibiotic that still has much to reveal.

Rev Esp Quimioter 2019; 32(Suppl.1)01-07 [Texto completo PDF ESPAÑOL ] [Full-text PDF ENGLISH]

 

 

/por
,

Rev Esp Quimioter 2019; 32(3):246-253


Meningitis/Encephalitis diagnosis in ICU using Multiplex PCR system: Is it time of change?

LUCÍA LÓPEZ-AMOR, DOLORES ESCUDERO, JAVIER FERNÁNDEZ, LORENA MARTÍN-IGLESIAS, LUCÍA VIÑA, JONATHAN FERNÁNDEZ-SUÁREZ, ÁLVARO LEAL-NEGREDO, BLANCA LEOZ, LAURA ÁLVAREZ-GARCÍA, CRISTIAN CASTELLÓ-ABIETAR, JOSÉ ANTONIO BOGA, FERNANDO VÁZQUEZ

Objetive. To evaluate the clinical impact of Meningitis/Encephalitis FilmArray® panel for the diagnosis of cerebral nervous system infection and to compare the results (including time for diagnosis) with those obtained by conventional microbiological techniques.
Patients and methods. A prospective observational study in an Intensive Care Unit of adults from a tertiary hospital was carried out. Cerebrospinal fluid from all patients was taken by lumbar puncture and assessed by the meningitis/encephalitis FilmArray® panel ME, cytochemical study, Gram, and conventional microbiological cultures.
Results. A total of 21 patients admitted with suspicion of Meningitis/Encephalitis. Median age of patients was 58.4 years (RIQ 38.1-67.3), median APACHE II 18 (RIQ 12-24). Median stay in ICU and median hospital stay was 4 (RIQ 2-6) and 17 days (RIQ 14-28), respectively. The overall mortality was 14.3%. A final clinical diagnosis of meningitis or encephalitis was established in 16 patients, obtaining the etiological diagnosis in 12 of them (75%). The most frequent etiology was Streptococcus pneumoniae (8 cases). FilmArray® allowed etiological diagnosis in 3 cases in which the culture had been negative, and the results led to changes in the empirical antimicrobial therapy in 7 of 16 cases (43.8%). FilmArray® yielded a global sensitivity and specificity of 100% and 90%, respectively. The median time to obtain results from the latter and conventional culture (including antibiogram) was 2.9 hours (RIQ 2.1-3.8) and 45.1 hours (RIQ 38.9-58.7), respectively.
Conclusions. The Meningitis/Encephalitis FilmArray® panel was able to establish the etiologic diagnosis faster than conventional methods. Also, it achieved a better sensitivity and led to prompt targeted antimicrobial therapy.

Rev Esp Quimioter 2019; 32(3):246-253 [Texto completo PDF]

 

 

/por
,

Rev Esp Quimioter 2019; 32(3):238-245


Initial clinical outcomes and prognostic variables in the implementation of a Code Sepsis in a high complexity University Hospital

FERNANDO RAMASCO, ANGELS FIGUEROLA, ROSA MENDEZ, DIEGO RODRÍGUEZ SERRANO, ANDRÉS VON WERNITZ, ANA HERNÁNDEZ-ACEITUNO, CARMEN SÁEZ, LAURA CARDEÑOSO, ELENA MARTIN, NIEVES GARCÍA-VÁZQUEZ, CARMEN DE LAS CUEVAS, NATALIA PASCUAL, AZUCENA BAUTISTA, DAVID JIMÉNEZ, GUILLERMO FERNÁNDEZ, ANA LEAL, MERCEDES VINUESA, ALBERTO PIZARRO, MARCELLO DI MARTINO, LOURDES DEL CAMPO, IÑIGO GARCÍA SANZ, MARTA CHICOT, ANA BARRIOS, MARÍA JOSÉ RUBIO, THE MEMBERS OF DE CODE SEPSIS H.U DE LA PRINCESA

Objectives. To assess the impact of the first months of application of a Code Sepsis in a high complexity hospital, analyzing patient´s epidemiological and clinical characteristics and prognostic factors.
Materials and methods. A long-term observational study was carried out throughout a consecutive period of seven months (February 2015 – September 2015). The relationship with mortality of risk factors, and analytic values was analyzed using uni- and multivariate analyses.
Results. A total of 237 patients were included. The in-hospital mortality was 24% at 30 days and 27% at 60 days. The mortality of patients admitted to Critical Care Units was 30%. Significant differences were found between the patients who died and those who survived in mean levels of creatinine (2.30 vs 1.46 mg/dL, p <0.05), lactic acid (6.10 vs 2.62 mmol/L, p <0.05) and procalcitonin (23.27 vs 12.73 mg/dL, p<0.05). A statistically significant linear trend was found between SOFA scale rating and mortality (p<0.05). In the multivariate analysis additional independent risk factors associated with death were identified: age > 65 years (OR 5.33, p <0.05), lactic acid > 3 mmol/L (OR 5,85, p <0,05), creatinine > 1,2 mgr /dL (OR 4,54, p <0,05) and shock (OR 6,57, P <0,05).
Conclusions. The epidemiological, clinical and mortality characteristics of the patients in our series are similar to the best published in the literature. The study has identified several markers that could be useful at a local level to estimate risk of death in septic patients. Studies like this one are necessary to make improvements in the Code Sepsis programs.

Rev Esp Quimioter 2019; 32(3):238-245 [Full-text PDF]

 

 

/por
,

Rev Esp Quimioter 2019; 32(3):254-262


Description of carbapenemase-producing Enterobacteriaceae isolates in a Spanish tertiary hospital. Epidemiological analysis and clinical impact

LAURA LÓPEZ-GONZÁLEZ, JOSÉ MANUEL VIÑUELA-PRIETO, ICÍAR RODRIGUEZ-AVIAL, ROCÍO MANZANO, FRANCISCO JAVIER CANDEL

Objectives. The aim of the study was to carry out an epidemiological analysis of patients with carbapenemase-producing Enterobacteriaceae (CPE) isolations in our hospital as well as to perform a description of the genotypic temporal evolution of CPE isolated.
Material and methods. An observational prospective cohort study was performed involving all patients with CPE isolates from clinical samples during November 2014 to November 2016 in a Spanish teaching hospital. Patients were clinically evaluated and classified either as infected or colonized. Information on the consumption of carbapenems in the hospital during the study period was also analyzed. PCR was used for identification of the carbapenemase genes blaKPC, blaVIM, and blaOXA-48.
Results. A total of 301 CPE isolates were obtained (107 in 2014, 89 in 2015 and 105 in 2016). Klebsiella pneumoniae (73.4%) was the most prevalent microorganism. Hundred and seventy (56.7%) of carbapenemases detected were blaOXA-48, 73 (24.3%) were blaKPC and 57 (19%) were blaVIM. In year 2014 KPC was predominant while in 2016 OXA-48 predominated. In 2014 we observed a significant association between the medical wards and the ICU with a higher prevalence of OXA-48 (OR 4.15; P<0.001) and VIM (OR 7.40; P<0.001) in the univariate analysis, in the following years there was no association. Regarding the clinical significance of microbiological results after assessing our patients, 60% of isolates represented infection and 40% behaved as colonizers. One third of hospitalized patients with CPE isolation died within 30 days, regardless of whether they were colonized or infected.
Conclusions. We have observed an epidemiological change in the genotypes of our isolates along the study period. A thorough knowledge of the CPE’s epidemiological distribution in each hospital is fundamental for optimizing antimicrobial chemotherapy.

Rev Esp Quimioter 2019; 32(3):254-262 [Full-text PDF]

 

 

/por
,

Rev Esp Quimioter 2019; 32(3):232-237


Hand hygiene compliance with hydroalcoholic solutions in medical students. Cross-sectional study

DIEGO RODRÍGUEZ-VILLAR, JUAN ANTONIO DEL-MORAL-LUQUE, JESÚS SAN-ROMÁN-MONTERO, ÁNGEL GIL-DE-MIGUEL, GIL RODRÍGUEZ-CARAVACA, MANUEL DURÁN-POVEDA

Objectives. To assess hand hygiene compliance covertly in medical students in a university teaching hospital.
Material and methods. Cross-sectional study. Hand hygiene compliance in medical students was assessed in the units of Neonatology, Paediatrics, Neurology and Orthopaedic surgery. The five moments were covertly observed so as the hand rub technique. Hand hygiene compliance was described with the compliance percentages of the five moments.
Results. We studied 456 opportunities of hand hygiene. Global compliance was 44.3%. The most registered unit was Orthopaedic surgery (59.6%). According to the different moments, global compliance was better “after touching a patient” (60.2%). The unit with the highest hand hygiene compliance was Neonatology (60%). Hand hygiene compliance was better in the different hospitalisation units (50%) than in the office rooms (33%) (P<0.05) and the mean duration of hand hygiene was 22 seconds.
Conclusions. Most of the moments were registered in the unit of Orthopaedic surgery and the moment with the highest hand hygiene compliance was “after touching a patient”. The most hand hygiene compliance percentage was observed in Neonatology. Hand hygiene compliance was moderate, and it could and must be improved.

Rev Esp Quimioter 2019; 32(3):232-237 [Texto completo PDF]

 

 

/por
,

Rev Esp Quimioter 2019; 32(3):224-231


Episodes of nontyphoidal salmonellosis in adult patients of the Valladolid West Area in 2017: Evaluation of the suitability of the microbiological culture request and the prescribed treatment

MÓNICA DE FRUTOS, RICARDO MEDINA, ROSA ARAGÓN, LUIS LÓPEZ-URRUTIA, MANUEL GONZÁLEZ-SAGRADO, CARMEN RAMOS, MARTA DOMÍNGUEZ-GIL, SONSOLES GARCINUÑO, LOURDES VIÑUELA, JOSÉ MARÍA EIROS

Introduction. Gastroenteritic salmonellosis is still the second cause diagnosed of infectious diarrhea, most of these clinical pictures are mild and self-limited and therefore the use of antibiotics is limited to few cases. The aim of the study was to describe the episodes of diarrhea caused by Salmonella enterica subsp. enterica, assessing the suitability of the request and the use of antibiotics according to the criteria included in the methodology.
Material and methods. A retrospective, descriptive, observational study was conducted, collecting data from the clinical history.
Results. A total of 122 episodes were included. The reason for consultation was diarrhea, which generated a greater demand in the Hospital Emergency Services (42.6%). The most frequent serotypes isolated were Enteritidis (53.3%), and Typhimurium (40.2%). The adequate request of the stool was 90.2%. Antibiotic was prescribed in 64.6% (79) of the episodes, most patients under 65 years (58 episodes), the average age was 48.43 years. They were treated mainly with ciprofloxacin and azithromycin, in 57 and 14 episodes, respectively. The average duration of antibiotic treatment was 6 days. There was an adequate use of antibiotics in 49.1% of episodes. When the origin of the request was the Hospital Emergency Service, it was inadequate in 63.5% (33) of them. It was inadequate in 60.0% (39) of episodes when ser. Enteritidis was isolated. Almost half, 48.85% (42) of the 58 episodes in which antibiotics were prescribed among those under 65 (86), were treated without being indicated.
Conclusions. Training actions should be implemented focused on optimizing the management of antibiotics in this entity.

Rev Esp Quimioter 2019; 32(3):224-231 [Texto completo PDF]

 

 

/por
,

Rev Esp Quimioter 2019; 32(3):217-223


Experience with nebulised colistin in patients with non-cystic fibrosis bronchiectasis colonised with Pseudomonas aeruginosa

MARÍA DEL MAR LÓPEZ-GIL OTERO, ELENA YAIZA ROMERO-VENTOSA, DÉBORA FEIJOO-MELÉNDEZ, CRISTINA CASANOVA-MARTÍNEZ, LUIS OTERO-MILLÁN, GUADALUPE PIÑEIRO-CORRALES

Introduction. Chronic colonisation/infection by Pseudomonas aeruginosa of the bronchiectasis is related to a faster deterioration of lung function, an increase in the number of exacerbations and a higher morbidity and mortality. Nebulised colistin decreases bacteria load. Therefore, a reduction in the number and in the severity of exacerbations and a delay of pulmonary decline is expected. The main objective is to evaluate if the treatment with nebulised colistin, for at least 6 months reduces the number of  admissions and visits to the emergency department.
Material and methods. Observational, retrospective and non-interventionist study carried out in an organizational structure with an integrated management. Patients with non-cystic fibrosis bronchiectasis colonised / infected by P. aeruginosa, older than 18 years, were selected. Patients must have received nebulized colistin during at least 6 months. Clinical, microbiological and therapeutic data from the patients were collected from the SERGAS computerized clinical history (IANUS® v.4.20.0503) and the electronic prescription, which were divided into two time periods: 1) 6 months pre-treatment and during the treatment and 2) 12 months pre-treatment and during the treatment, in those who completed 1 year of treatment.
Results. Forty-four patients were included and of these, 29 (65.9%) had a follow-up of 12 months. The use of nebulized colistin decreased significantly the number of visits to the emergency (at 6 months), the frequency and duration of hospitalizations admissions (at 6 and 12 months), the antibiotic consumption (at 6 and 12 months) and the positive cultures. The treatment was well tolerated in almost all patients.
Conclusions. The treatment with nebulised colistin during 6 and 12 months of non-cystic fibrosis bronchiectasis, colonised/infected by P. aeruginosa, seems beneficial for the patient, from the clinical and quality of life point of view, and could reduce the economic cost of the process.

Rev Esp Quimioter 2019; 32(3):217-223 [Texto completo PDF]

 

 

/por
,

Rev Esp Quimioter 2019; 32(3):268-272


Effect of the administration of a probiotic with a combination of Lactobacillus and Bifidobacterium strains on antibiotic-associated diarrhea

OLIVIA GARCÍA TRALLERO, LUIS HERRERA SERRANO, MONTSE BIBIÁN INGLÉS, DAVID ROCHE VALLÉS, ANA MARÍA RODRÍGUEZ

Objectives. The aim of this study is to analyze the effect, safety and tolerability of a specific probiotic combination of Lactobacillus and Bifidobacterium strains (Pearls IC©) on antibiotic associated diarrhea due to amoxicillin-clavulanic acid treatment.
Patients and methods. Pilot, unicentric, randomized, double-blind, parallel group, placebo-controlled study (probiotic vs. placebo for 30 days). Target population: Adult patients, both sexes treated with amoxicillin-clavulanic acid (850mg / 125mg every 8h /orally) for 7 days who attended the Emergency Department (Dexeus Hospital, Barcelona) between January and April of 2018 with prior signed informed consent with a follow up at 30 days. Variables: The differences between day 0 and day 30 of the number of daily stools and duration of diarrhea were evaluated; Stool consistency according to Bristol Stool Form, Quality of intestinal life. Subjective evaluation and evaluation of adverse effects of the product through a specifically designed questionnaire.
Results. Thirty-six subjects were included (18 per group) 25 females and 11 males, average age of 38.5 years (range 19-65 years). Pearls IC© delayed between 4 and 5 days the appearance of the diarrheic episode vs. placebo (p <0.001). The results of the quality of life assessment showed an improvement at the end of the 30 days period but without difference vs placebo. The results of the subjective assessment were in favor of the probiotic with higher rate of like responses than placebo.
Conclusions. Pearls IC© demonstrated its beneficial effect on antibiotic associated diarrhea by delaying the onset of diarrhea and showed a tendency to decrease the number of daily stools vs. placebo.

Rev Esp Quimioter 2019; 32(3):268-272 [Full-text PDF]

 

 

/por
,

Rev Esp Quimioter 2019; 32(2): 165-177


Information on nosocomial infections in the mainstream media: an opinion document

EMILIO BOUZA, SERGIO ALONSO, ANGEL ASENSIO, GUILLERMO DE JUAN, CRISTINA GARCÍA LUCIO, CORAL LARROSA, JAVIER LÓPEZ-IGLESIAS, PATRICIA MUÑOZ, ROSALÍA SIERRA, JOSÉ PERIANES, JOSÉ LUIS DE LA SERNA, ESTEBAN PALOMO, DIEGO GRACIA

This paper seeks to explore the reasons for the low impact of nosocomial infection in the mainstream media and the responsibilities of physicians and journalists in terms of this situation. To this end, a small group of 13 experts met for round-table discussions, including physicians with expertise in nosocomial infection, medical lawsuits and ethics, as well as journalists from major mainstream Spanish media outlets. The various participants were asked a series of questions prior to the meeting, which were answered in writing by one of the speakers and discussed during the meeting by the whole group, the aim being to obtain consensual conclusions for each of them. The document was subsequently reviewed, edited and forwarded to all co-authors for their agreement. The opinions expressed are the personal opinions of the participants and not necessarily those of the institutions in which they work or with which they collaborate.

Rev Esp Quimioter 2019; 32(2): 165-177 [Full-text PDF]

 

 

/por
,

Rev Esp Quimioter 2019; 32(2): 98-113


Austrian syndrome: A rare manifestation of invasive pneumococcal disease. A case report and bibliographic review

MARTA RODRÍGUEZ NOGUÉ, IGNACIO GÓMEZ ARRAIZ, GEMA ARA MARTÍN, Mª MAR FRAJ VALLE, ANTONIO GÓMEZ PELIGROS

The Austrian syndrome is a pathology caused by disseminated Streptococcus pneumoniae infection and characterized for the triad of pneumonia, endocarditis and meningitis. It has an estimated incidence of 0.9-7.8 cases per ten millions people each year, and a mortality of 32%. Alcohol abuse, as the main risk factor, appears only in four out of ten patients. Moreover, 14% of patientes do not have any risk factor. Two out of three patients are males and it occurs in the middle aged of life. It is more frequently on native valve, aortic valve is injured in the half of the cases. Severe regurgitation occurs in two per three patients. Appropriate antimicrobial treatment and early endocarditis surgery decrease mortality. It is possible that Austrian syndrome epidemiology is changing by the introduction of 13-valent pneumococcal conjugated vaccine in the children´s calendar.

Rev Esp Quimioter 2019; 32(2): 98-113 [Texto completo PDF]

 

 

/por