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Rev Esp Quimioter 2018; 31(5):419-426

Antimicrobial stewardship programme implementation in a medical ward

JESÚS RUIZ, MIGUEL SALAVERT, PAULA RAMÍREZ, MARTA MONTERO, IVÁN CASTRO, EVA GONZÁLEZ, EVA ROMÁ, JOSÉ LUIS POVEDA

Introduction. Antimicrobial stewardship programmes (ASP) have proven to be effective tools for reducing the use of antimicrobials. The purpose of the study is to evaluate the effect of an ASP implantation in a medical Ward.
Material and methods. Prospective intervention study in a medical ward with a heterogeneous composition. In September 2014, an ASP based on prospective audits was implemented. Antimicrobial consumption and the length of stay and mortality in all patients admitted, as well as in the main infections present in the unit, were compared before and after two years of the ASP implementation.
Results. A total of 378 infectious episodes of 335 pa-tients were evaluated in 168 meetings. The prescriber ac-cepted 92.3% of the suggestions. The consumption of an-timicrobials reviewed was reduced from 31.3 to 17.6 DDD / 100-stays (β =-0.40, P = 0.015). The average cost per income was reduced from € 161.4 to € 123.3 (-23.6%). No differences were found in total length of stay or mortality. There were no changes in the incidence of Clostridium difficile infection or candidemia between the two periods. There were no significant differences in length of stay or mortality in total bacteremia, candidemia, and urinary tract infections caused by multiresistant bacteria.
Conclusions. The implementation of an ASP in a heterogeneous medical ward significantly reduces the use of antimicrobials in a short time horizon without adversely affecting the evolution of the patients.

Rev Esp Quimioter 2018; 31(5):419-426 [Texto completo PDF]

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Rev Esp Quimioter 2018; 31 (Suppl. 1): 62-65

Top-ten papers in Infection Control (2015-2017)

BEATRIZ DIETL, ESTHER CALBO

Healthcare-associated infections are a main Public Health challenge. In the era of antimicrobial resistance, more effective Infection Control Programs are needed. In this review we will discuss some publications related to hand hygiene (should the patients participate in the improvement programs?); some new strategies to enhance terminal room disinfection and important controversies on contact precautions policies (should we abandon them?). In the last year, there have been as well some reports that provide new insights in Clostridium difficile infection and in the impact of educational antimicrobial stewardship programs.

Rev Esp Quimioter 2018; 31(Suppl. 1): 62-65 [Full-text PDF]

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Rev Esp Quimioter 2018; 31 (Suppl. 1): 56-61

Central nervous system infections in immunocompromised patients

IVÁN CASTRO, JESÚS RUIZ, MARÍA TASIAS, MARTA MONTERO, MIGUEL SALAVERT

Diagnosis of CNS infections remains a great challenge in immunocompromised patients with solid cancer or hematological disorders, as it happens with transplant recipients, since symptoms might both be masked and be mimicked by other conditions such as metabolic disturbances or consequences of antineoplastic treatment and the administration of immunosuppressive drugs. Thus, awareness of this complication is crucial and any suspicion of a CNS infection should lead to make an early diagnosis and to choose an appropriate empirical treatment to improve the outcome in this population.

Rev Esp Quimioter 2018; 31(Suppl. 1): 56-61 [Full-text PDF]

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Rev Esp Quimioter 2018; 31 (Suppl. 1): 52-55

Highlights in solid transplant infectious diseases 2015-2017

JOSE TIAGO SILVA, FRANCISCO LÓPEZ-MEDRANO, JOSE MARIA AGUADO

Solid organ transplant recipients have an increased risk of developing infections due to the lifelong treatment with immunosuppressive drugs. Herein we review recent (2015-2017) and relevant published advances in the field of bacterial, viral and fungal-infections in this population. We also address the most up-to-date immunological assays that can predict the risk of infection. Finally, we review current guidelines and how they improve the usual clinical care.

Rev Esp Quimioter 2018; 31(Suppl. 1): 52-55 [Full-text PDF]

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Rev Esp Quimioter 2018; 31 (Suppl. 1): 47-51

Top-ten infections in onco-hematological patients (2015-2017)

ISABEL RUIZ CAMPS, JUAN AGUILAR COMPANY

To choose the most relevant ten papers constitutes a challenge in several ways. We have elaborated this selection based on the papers we find to be most useful and ground-breaking for the clinician faced daily by the infectious problems in onco-hematological patients. The selection has been structured in four parts: bacterial infections, viral infections, fungal infections and infections related with new drugs in onco-hematological patients.

Rev Esp Quimioter 2018; 31(Suppl. 1): 47-51 [Full-text PDF]

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Rev Esp Quimioter 2018; 31 (Suppl. 1): 43-46

Usefulness of biomarkers on infection management: with or without them?

FERNANDO MARTÍNEZ-SAGASTI, ELENA VELASCO-LÓPEZ, SARA DOMINGO-MARÍN, JOSÉ
MIGUEL GIL-PERDOMO

Infectious diseases are disorders caused by many different microorganisms that produce clinical conditions with a wide variation in patient-rated symptoms and severity. Therefore, different diagnostic and prognostic tools are needed to help make the most accurate decisions at each moment of patient´s care with suspected infection. This mini review will analyse how some biomarkers reduce the level of uncertainty in the making decision process at some phases of sepsis, including prompt identification of septic patients, early initiation of empiric broad-spectrum antimicrobials, regimen and duration.

Rev Esp Quimioter 2018; 31(Suppl. 1): 43-46 [Full-text PDF]

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Rev Esp Quimioter 2018; 31 (Suppl. 1): 39-42

Practical Decalogue in the management of sepsis

JUAN GONZÁLEZ DEL CASTILLO, MARÍA JOSÉ NÚÑEZ ORANTOS, FRANCISCO JAVIER CANDEL,
FRANCISCO JAVIER MARTÍN-SÁNCHEZ

Sepsis is a complex entity where there are still many controversies regarding diagnosis and therapeutic management. The present article pretends to review the recently published in relation to these disagreements and contains a proposal of practical approach to the infected patient..

Rev Esp Quimioter 2018; 31(Suppl. 1): 39-42 [Full-text PDF]

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Rev Esp Quimioter 2018; 31 (Suppl. 1): 35-38

Fungal biofilms: From bench to bedside

MELANIA ÍÑIGO, JOSÉ LUÍS DEL POZO

Biofilms cause recurrent invasive infections that are difficult to eradicate because of their high resistance to antimicrobials and host defence mechanisms. Fungal biofilm-related infections are associated with high mortality rates. Although current guidelines recommend catheter removal for catheter-related bloodstream infections due to Candida species, several studies have shown that the efficacy of the antifungal lock technique. The use of combinations of antifungal agents may improve the management of biofilm-related fungal infections and prevent the emergence of resistance associated with monotherapy. Since the presence of mixed bacterial-fungal biofilm infections is very prevalent, a combination of antibacterial and antifungal agents should be considered.

Rev Esp Quimioter 2018; 31(Suppl. 1): 35-38 [Full-text PDF]

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Rev Esp Quimioter 2018; 31 (Suppl. 1): 32-34

Top-ten papers in fungal infection (2015-2017)

PEDRO PUERTA-ALCALDE, CELIA CARDOZO, ALEX SORIANO, CAROLINA GARCÍA-VIDAL

We have clustered the published articles in fungal infection between 2016 and 2017 in four categories. First, the emergence of Candida auris as a nosocomial pathogen associated to high antifungal resistance and high mortality. Second, the growing importance of fungal infections associated to the use of biologic therapies. Third, the approval of isavuconazole for the treatment of filamentous fungi and dymorphic mycoses with positive results and less side effects. And finally, a mix of other important news regarding empiric therapy, fluconazole toxicity and difficult-to-treat fungal infections..

Rev Esp Quimioter 2018; 31(Suppl. 1): 32-34 [Full-text PDF]

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Rev Esp Quimioter 2018; 31 (Suppl. 1): 27-31

A comprehensive approach for the patient with Clostridium difficile infection

JAVIER COBO

During the last decade there have been many changes and advances in the research on Clostridium difficile infection (CDI). We have improved diagnostic and therapeutic tools and, at the same time, we have learned that the CDI implies, especially in the most vulnerable patients, an important morbidity.
CDI has traditionally been undervalued and it is widely dispersed in hospitals. Surely, there is inertness in its management and there are also broad areas of improvement. If we add to this the high cost of the new drugs and the practical difficulties to implement the faecal microbiota transplant, we realize that we may not be taking full advantage of all the opportunities to improve patient’s outcomes. The implementation of policies that favour the supervision of all CDI cases by an expert in infectious diseases will contribute to a better global management of this important disease.

Rev Esp Quimioter 2018; 31(Suppl. 1): 27-31 [Full-text PDF]

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