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Rev Esp Quimioter 2019; 32(4):333-364

The situation of vaccines for the prevention of infections in adults: An opinion paper on the situation in Spain 

EMILIO BOUZA, JULIO ANCOCHEA-BERMÚDEZ, MAGDA CAMPINS, JOSÉ MARÍA EIRÓS-BOUZA, JESÚS FARGAS, AMÓS JOSÉ GARCÍA ROJAS, DIEGO GRACIA, ALIPIO GUTIÉRREZ SÁNCHEZ, AURORA LIMIA, JOSÉ ANTONIO LÓPEZ, MARÍA DEL CARMEN MAGRO, GLORIA MIRADA, PATRICIA MUÑOZ, EDUARDO OLIER, RAÚL ORTIZ DE LEJARAZU, LUIS URBIZTONDO, ESTEBAN PALOMO

The childhood immunization schedule is well known and generally well implemented in developed countries. For various reasons, the same is not true of vaccines aimed at preventing infections in adults, in which vaccination coverage is incomplete and generally very deficient. In order to assess the situation of adult vaccination in Spain, the Fundación de Ciencias de la Salud has brought together a series of experts in different fields, including doctors, nurses, representatives of patient associations, health managers and economists, health authorities and journalists to deal with this issue. The format was that of a round table in which a series of questions previously formulated by the coordinators were to be answered and debated. The document presented is not an exhaustive review of the topic, nor is it intended to make recommendations, but only to give a multidisciplinary opinion on topics that could be particularly debatable or controversial.  The paper reviews the main vaccine-preventable adult diseases, their clinical and economic impact, the possibilities of reducing them with vaccination programmes and the difficulties in carrying them out. The role of nursing, pharmacy services, patient associations and the health administration itself in changing the current situation was discussed. Prospects for new vaccines were discussed and we speculated on the future in this field. Finally, particularly relevant ethical aspects in decision-making regarding vaccination were discussed, which must be faced by both individuals and states. We have tried to summarize, at the end of the presentation of each question, the environment of opinion that was agreed with all the members of the table.

Rev Esp Quimioter 2019; 32(4):333-364 [Full-text PDF]

 

 

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Rev Esp Quimioter 2019; 32(4):375-378

Is it possible to extrapolate the rates of resistance of Escherichia coli from asymptomatic bacteriuria in pregnant women to those of E. coli in uncomplicated community-acquired UTI? 

ALEJANDRA ASENJO, MARTÍN C. GRADOS, JESÚS OTEO-IGLESIAS, JUAN-IGNACIO ALÓS

Objective. Treatment of uncomplicated urinary tract infections in primary care is generally empirical without requesting urine culture and based on biased resistance data collected from selected patients, most of them having risk factors for the isolation of resistant microorganisms. In order to overcome the lack of information on the real resistance rates in uncomplicated UTI, we compared antimicrobial phenotype and genotype of Escherichia coli isolated from pregnant women with asymptomatic bacteriuria (culture always performed) with those from women with uncomplicated acute cystitis (culture rarely performed) of different age groups.
Material and methods. Between September 2017 and March 2018, 103 urines were randomly collected from pregnant women aged between 16 and 47 with asymptomatic bacteriuria (AB) (n=42), not hospitalized women in the same age range with uncomplicated acute cystitis (UAC) (n=31) and women older than 47 not hospitalized with UAC (n=30). Bacteria identification was performed using mass spectrometry and the antibiogram by broth microdilution. Genetic typification was carried out by pulsed-field gel electrophoresis.
Results. There are no significant differences between the groups of patients in the antibiotic susceptibility. Likewise, as expected, a wide genetic diversity is observed among the strains of E. coli studied without significant differences between the three groups.
Conclusions. We propose a simple model that could provide better guidance for selection of empirical antimicrobial therapy for non-pregnant women with UAC than do generic hospital antibiogram data based on reliably extrapolating the susceptibility data of strains isolated from pregnant women with AB as representation of women with community-acquired UAC.

Rev Esp Quimioter 2019; 32(4):375-378 [Full-text PDF]

 

 

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Rev Esp Quimioter 2019; 32(4):317-326

Hospital admission and mortality causes of HIV patients in a third level hospital 

ROCÍO ASENSI-DIEZ, CRISTINA FERNÁNDEZ-CUERVA, JUAN JOSÉ ALCARAZ SÁNCHEZ, ISABEL MUÑOZ-CASTILLO

Introduction. The aim of this study is to describe the HIV population admitted to a tertiary level hospital and analyze hospital admission and mortality causes during hospitalization.
Material and methods. Observational, retrospective study carried out in a third level Hospital. Inclusion criteria: Patients ≥18 years with a prescription of ART and diagnosis of HIV known or discovered during admission. It was accepted hospital ward discharge diagnose as hospitalization causes. Clinical, analytical outcomes as well as causes of mortality were collected.
Results. Among 162 hospitalized HIV infected, 128 met the inclusion criteria, 8 of those were diagnosed as naive HIV patients. 79.7% were male; Age 50.29 ± 9.81 years. The main reasons for hospital admissions (38.3%) were certain infectious and parasitic diseases (ICD-10 Classification) and more specifically human immunodeficiency virus [HIV] disease represented 24,1% of whole hospitalizations. Mortality rates of ≥18 years HIV patients that were admitted to hospital during 2016-2017 were the 13.52%. The main causes of death were certain infectious and parasitic diseases followed by malignancies.
Conclusions. Our results emphasize the need of intensifying the HIV early diagnosis as well as Pneumocystis jirovecii primary prophylaxis. Insist on ART adherence from infectology follow-up appointment and pharmacy care consultations, educate clinics on ART treatment prescription during hospital admission as well as requesting viral and CD4 lymphocytes loads to every HIV admitted patients.

Rev Esp Quimioter 2019; 32(4):317-326 [Texto completo PDF]

 

 

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Rev Esp Quimioter 2019; 32(4):370-374

Evaluation of a rapid assay for detection of PBP2a Staphylococcus aureus 

ROCÍO SÁINZ-RODRÍGUEZ, INMACULADA DE TORO-PEINADO, MIRIAM VALVERDE-TROYA, Mª PILAR BERMÚDEZ RUÍZ, BEGOÑA PALOP-BORRÁS

Background. Methicillin-resistant Staphylococcus aureus (MRSA) is a significant pathogen causing both healthcare-associated and community-acquired infection. Rapid and accurate detection of this pathogen is crucial for the use of appropriate antimicrobial therapy and the control of nosocomial spread.
Methods. A total of 107 S. aureus strains were assayed for methicillin resistance: Vitek2® (bioMérieux), CHROMagarTM MRSA II (BD Becton Dickinson), disk diffusion in agar for cefoxitin 30 μg and immunochromatography PBP2a SA Culture Colony Test (AlereTM). The results of conventional tests were compared with the “gold standard” PCR test for mecA gene.
Results. Sensitivity and specificity were: disk diffusion for cefoxitin 100% and 100% respectively, Vitek2® 100 and 100%, CHROMagarTM MRSA II 100 and 96%, and ICPBP2a detection 98,25% and 100%.
Conclusion. ICPBP2a Culture Colony Test (AlereTM) is fast, efficient and economical technique for detection of penicillin binding protein 2a (PBP2a) from isolates. This assay is a useful tool for the management of hospital outbreaks.

Rev Esp Quimioter 2019; 32(4):370-374 [Texto completo PDF]

 

 

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Rev Esp Quimioter 2019; 32(4):365-369

Comparison of two methods skipping cell lysis and protein extraction for identification of bacteria from blood cultures by matrix-assisted laser desorption/ionization time-of-flight mass-spectrometry 

IGNACIO TORRES, ESTELA GIMÉNEZ, DIXIE HUNTLEY, MIREIA MARTÍNEZ, JAVIER COLOMINA, DAVID NAVARRO

Objective. Matrix-assisted laser desorption/ionization time-of-flight mass-spectrometry (MALDI-TOF MS) is widely used for fast identification of bacteria from blood cultures (BC). We compared the performance of two procedures, one including a pre-enrichment step in brain heart infusion and the other a direct method using vacutainer separator gel tubes (DI), for identification of bacteria from blood cultures by MALDI-TOF MS.
Material and methods. We first prepared a training set of 20 simulated bacteremia specimens, including 10 Gram-negative and 10 Gram-positive species. A total of 145 non-consecutive BCs flagged as positive (68 Gram-negative rods, and 77 Gram-positive cocci) were prospectively analyzed (validation set).
Results. A total of 82% and 49% of isolates were correctly identified to the species level by the respective methods.
Conclusion. The pre-enrichment method outperformed the DI method for identification of virtually all bacterial species included in the panels.

Rev Esp Quimioter 2019; 32(4):365-369 [Full-text PDF]

 

 

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Rev Esp Quimioter 2019; 32(4):311-316

Risk factors to secondary nosocomial bacteremia to UTI in a tertiary hospital 

LAURA SANTE, MARÍA LECUONA,  ARMANDO AGUIRRE JAIME, ÁNGELES ARIAS

Introduction. Nosocomial bacteremia secondary to urinary tract infections (NBS-UTI) occur in 1-4% of episodes and the associated mortality can increase up to 33%. However, very little is known about the epidemiology of these infections. The determination of modifiable risk factors to develop this type of bacteremia could help to control the infection and reduce health costs.
Material and methods. Cases-control study of NBS-UTI diagnosed at the University Hospital of Canary Islands between 2010-2014. The clinical-epidemiological variables and the intrinsic and extrinsic potential risk factors were collected. Logistic regression was used to study the variables associated with the development of NBS-UTI.
Results. A total of 178 episodes were studied, 85 cases and 93 controls. The average stay was significantly greater in the cases; from admission to bacteremia (p <0.003), as well as from discharge to discharge (p <0.005). Hepatic insufficiency (p <0.091), the use of mechanical ventilation (p <0.001), the central venous catheter (p <0.043) and surgery in the episode (p <0.001) behaved as risk factors for the acquisition of NBS-ITU.
Conclusion. Invasive devices, such as central venous catheter and mechanical ventilation, that had not previously been studied; as well as the surgery in the episode, which had not been studied either, suppose risk factors. In addition, NBS-ITU causes a significant increase in hospital stay. Therefore, it is necessary to know the risk factors for the appearance of these infections, and thus prevent their appearance and improve the safety of hospitalized patients.

Rev Esp Quimioter 2019; 32(4):311-316 [Texto completo PDF]

 

 

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Rev Esp Quimioter 2019; 32(4):327-332

Prevalence of genital Mycoplasma and response to eradication treatment in patients undergoing assisted reproductive techniques 

ERNESTO VEIGA, MERCEDES TREVIÑO, ANA BELÉN ROMAY, DANIEL NAVARRO, ROCÍO TRASTOY, MANUEL MACÍA

Introduction. Several studies have reported greater success of fertilisation by ART in couples who were not infected by Ureaplasma. Increased semen quality and better results have also been observed in couples who were treated with antibiotics to eradicate the infection. The aim of this study was to determine the prevalence of genital mycoplasmas in urine samples from male partners enrolled in the Assisted Reproduction Program (ARP) in our healthcare area so that, positive cases can be treated prior to the use of ART in order to increase the quality of semen, improve the embryo implantation rates and minimize the risk of adverse effects during pregnancy.
Material and methods. This study included couples enrolled in the ARP during 2016. Mycoplasma detection was made using real-time PCR. In positive cases, both members of the couple were treated with antibiotics until eradication of the microorganism. The antibiotics used were: azithromycin, doxycycline, levofloxacin, moxifloxacin, and clindamycin.
Results. Of the 205 men studied, 33 were positive: Ureaplasma urealyticum 15.1%, Mycoplasma hominis 3.9%. Eradication treatment with azithromycin failed in 50% compared to 10.2% for doxycycline. Of the 5 cases treated with levofloxacin, only 2 achieved elimination of U. urealyticum.
Conclusions. We consider that genital mycoplasma routine screening could be useful in order to increase the quality of semen which could simplify the in vitro fertilisation procedures and raise the success rate of embryo implantation and pregnancy, especially when fast, sensitive and specific technics as real time PCR are used.

Rev Esp Quimioter 2019; 32(4):327-332 [Full-text PDF]

 

 

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Rev Esp Quimioter 2019; 32(4):303-310

Drug-resistant bacteria on hands of healthcare workers and in the patient area: an environmental survey in Southern Italy’s hospital 

VINCENZA LA FAUCI, GAETANO BRUNO COSTA, CRISTINA GENOVESE, MARIA ANGELA RITA PALAMARA, VALERIA ALESSI, RAFFAELE SQUERI

Background. The WHO recognized antimicrobial resistance as a growing global health threat with a wide variability across Europe: in Italy these rates are higher than in other countries. The aim of our study was to detect antimicrobial resistance on the hands of healthcare workers and on surfaces around the patient, to assess the variability between levels of bacterial contamination on these surfaces and to compare the results with those achieved six years ago.
Material and methods. The study was conducted from June 2017 to May 2018 using contact slides for surfaces and active sampling for air. We used automated biochemical methods to identify microorganisms; antibiograms were performed in compliance with the EUCAST expert rules.
Results. We analyzed 3,760 samples, 16.17% were found positive and 34 % of these were antimicrobial-resistant. On analyzing the isolated Staphylococci, 39% were multidrug-resistant and 5% extensively drug-resistant. A 30% of the Enterococcus faecalis isolates were resistant to gentamycin and vancomycin. We found Klebsiella pneumoniae isolates resistant to ceftriaxone, cefoxitin, mecillinam and imipenem. A 7% and 8% of the Acinetobacter baumannii and Pseudomonas aeruginosa isolates, respectively, were resistant to gentamicin, imipenem, and ceftazidime.
Conclusions. These findings are in line with the international literature, confirming that antimicrobial resistance is also steadily growing in Italy with rates varied for the different pathogens.

Rev Esp Quimioter 2019; 32(4):303-310 [Full-text PDF]

 

 

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Rev Esp Quimioter 2019; 32(4):296-302

Effectiveness of 12 week ledipasvir/sofosbuvir and predictors of treatment failure in patients with hepatitis C

JUAN CARLOS DEL RIO-VALENCIA, ROCÍO ASENSI-DIEZ, ROCÍO TAMAYO-BERMEJO, ISABEL MUÑOZ-CASTILLO

Introduction. The efficacy of ledipasvir/sofosbuvir (LDV/SOF) have been demonstrated in randomized controlled trials, however,there is an unmet need for real-world effectiveness data. It is important to gather data regarding potential predictors of treatment failure with (LDV/SOF). Predictors of sustained virologic response (SVR) to all-oral HCV regimens can inform nuanced treatment decisions. The objectives of this study were to evaluate the effectiveness of LDV/SOF, SVR12 as main endpoint and SVR24 as second endpoint, and identify predictors of treatment failure.
Material and methods. Retrospective and observational study carried out from April 2015 to January 2016. Inclusion criteria: patients with HCV infection treated with LDV/SOF for 12 weeks during study period. The patients that were treated during 24 weeks were excluded as well as those treated with peg-interferon. Binary logistic regression was used to predict what variable was associated with treatment failure.
Results. A total of 122 patients were analyzed achieving SVR12 91.80% (112/122) of them. The patients with HCV genotype (GT) 1a or GT1b or GT4 achieved SVR12. Only one pre-treated non-cirrhotic HCV GT1 patients relapsed to treatment. The lowest SVR12 were obtained for GT3, 43.75%, (7/16). Everybody that got SVR12 achieved SVR24. None of the variables analyzed significantly influenced the SVR12, except GT (p=0.001). Almost all the relapses occurred in GT3.
Conclusion. LDV/SOF combination has been very effective to treat GT1 and GT4 infected patients, however, has constituted a suboptimal therapeutic option for those patients infected with GT3, regardless of the rest of the variables analyzed.

Rev Esp Quimioter 2019; 32(4):296-302 [Full-text PDF]

 

 

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Rev Esp Quimioter 2019; 32(4):288-295


Guillain-Barré syndrome and influenza vaccines: current evidence

ROSARIO SANZ FADRIQUE, LUIS MARTÍN ARIAS, JUAN ARCADIO MOLINA-GUARNEROS, NATALIA JIMENO BULNES, PILAR GARCÍA ORTEGA

Purpose. Guillain-Barré Syndrome (GBS) as a consequence of influenza vaccination is a relevant topic, yet to be clarified, which raises concern both amongst health care personnel and the general population. Every study and pharmacovigilance system point to need of further research and the importance of continuous monitoring of safety regarding influenza vaccines. The aim of the present study is to investigate the publication of new data since the realisation of our meta-analysis of GBS and influenza vaccines (published in 2015).
Methods. A systematic revision of PubMed, Embase, and Web of Knowledge (WOS) databases has been carried out. These report observational studies assessing GBS risk after the administration of influenza vaccines from May 2014 up to July 20th, 2017.
Results. The research yielded 107 articles. Only three studies met established inclusion criteria and referred to an estimation GBS risk after some influenza vaccine. Two studies investigated GBS risk by the pandemic A/H1N1 vaccine, while only one looked into season vaccines.
Conclusions. The present systematic review, conducted after the publication of our previous meta-analysis, seems to confirm its previous results. Therefore, GBS should be considered an infrequent adverse effect of influenza vaccination, which should not negatively influence its acceptance. Unfortunately, very few of the systematically surveyed studies meeting inclusion criteria. This fact sharply contrasts with the current consensus as to the need of continuously monitoring the safety of influenza vaccines.

Rev Esp Quimioter 2019; 32(4):288-295 [Full-text PDF]

 

 

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