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Rev Esp Quimioter 2018; 31(5):427-434

Risk factors and clinical evolution of carbapenemase-producing Klebsiella pneumoniae infections in a university hospital in Spain. Case-control study

VÍCTOR ROJO, PEDRO VÁZQUEZ, SAGRARIO REYES, LUCÍA PUENTE FUERTES, MIGUEL CERVERO

Introduction. Carbapenemase-producing Enterobacterias is a global health hazard due to their ease of transmission, difficulty of treatment, and their personal and economic impact. We analyze the factors associated with an increased risk of infection by Klebsiella pneumoniae carbapenemase-producing bacteria (KPC) and factors related to poor prognosis.
Materials and methods. We designed a case-control study. KPC isolates were taken during an outbreak in a hospital in Madrid. A logistic regression was performed with the main variables.
Results. Sixteen cases of clinically documented infections were isolated. Overall mortality rates in the cases group was 25%. The most frequent location was blood (37.5%) followed by urine (25%). All but one were OXA-48. Regarding factors related to an increased risk of developing infection, only previous exposure to antibiotics presented statistical significance difference OR 13 (2.40-70.46). With respect to the overall mortality, the presence of pneumonia OR 25 (1.93-323.55) or the use of invasive mechanical ventilation was associated with greater risk 15 OR 33 (1.92-122.8) For attributable mortality only invasive ventilation had a significant association OR 18 (1.48-218.95).
Conclusions. Exposure to previous antibiotics is an independent risk factor for developing KPC infection, adjusted for all other clinical and demographic variables. Risk factors such as the presence of pneumonia or the use of invasive mechanical ventilation were associated with a worse prognosis in terms of overall and attributable mortality.

Rev Esp Quimioter 2018; 31(5):427-434 [Texto completo PDF]

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Rev Esp Quimioter 2018; 31(5):411-418

Fecal microbiota transplantation for recurrent Clostridium difficile infection: Experience, protocol, and results

ELENA REIGADAS, MARÍA OLMEDO, MARICELA VALERIO, SILVIA VÁZQUEZ-CUESTA, LUIS ALCALÁ, MERCEDES MARÍN, PATRICIA MUÑOZ, EMILIO BOUZA

Background. Fecal microbiota transplantation (FMT) is a highly effective therapy for recurrent Clostridium difficile infection (R-CDI). Despite its excellent efficacy, it is still not a routine procedure in most European centers. FMT has not been widely used in Spain to date. We describe our experience with FMT, including a novel approach based on oral fecal capsules.
Methods. We analyzed a prospectively recorded case series of patients with R-CDI treated with FMT at a single center (June 2014-July 2017). Primary outcome was defined as resolution of CDI without recurrence in a two-month period. FMT was administered via colonoscopy, nasojejunal tube, or oral capsules. All stool donors were rigorously screened.
Results. FMT was performed in 13 patients with R-CDI. Median age was 75.0 years and 76.9% were females. Six FMT were performed via nasojejunal tube, 5 via oral capsules, and 2 by colonoscopy. There were no procedure-related adverse events, except for bacteremia in one patient. During follow-up, R- CDI was observed in one patient at one month after FMT. The primary resolution rate was 83.3% and the overall resolution rate was 91.7%. FMT by capsules achieved a 100% resolution rate, colonoscopy 100%, and nasojejunal tube 80.0%.
Conclusions. In our cohort, FMT proved to be safe and effective, even in high risk patients. Oral administration in capsules also proved to be safe, well-tolerated, and highly effective for R-CDI. In our experience, the FMT capsule formulation seems feasible in the routine of a hospital. This administration method will allow FMT to be more widely used.

Rev Esp Quimioter 2018; 31(5):411-418 [Full-text PDF]

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Rev Esp Quimioter 2018; 31(5):406-410

Colistin resistance due to insertional inactivation of the mgrB in Klebsiella pneumoniae of clinical origin: First report from India

ANIL KUMAR, LALITHA BISWAS, NEHA OMGY, KARTHIKA MOHAN, VIVEK VINOD, ANJALI SAJEEV, PREM NAIR, SANJEEV SINGH, RAJA BISWAS

Objectives. Mutations in mgrB, phoP/phoQ, pmrA, pmrB, pmrC, and crrABC regulatory systems have been found responsible for colistin resistance. The aim of our study was to investigate the role of alteration in mgrB gene and plasmid mediate mcr-1 and mcr-2 genes as a source of colistin resistance in 17 non duplicate Klebsiella pneumoniae clinical isolates.
Methods. All isolates classified as resistant to colistin by VITEK 2 system (BioMerieux, Marcy I’ Etoile, France) were included. Susceptibility to colistin was also determined by broth microdilution using breakpoints recommended by EUCAST (>2mg/L resistant; and ≤2mg/L susceptible). PCR amplification of mgrB gene was performed and sequenced using specific primers. Presence of mcr-1 and mcr-2 was also investigated using PCR.
Results. PCR amplification of the mgrB gene of the 17 K.pneumoniae isolates revealed a larger (~1000bp) amplicon in three isolates when compared with the wild type mgrB ampiclon (250 bp). Sequencing of these amplicons showed that mgrB was disrupted by the insertion of ISKpn14, a IS element belonging to the IS1 family. Sequencing, of the 250 bp mgrB gene in the remaining 14 isolates revealed frame shift mutation after the second codon leading to a premature stop codon in only one isolate.
Conclusions. The study showed that colistin resistance in 20% of the K. pneumoniae isolates was due to loss of function of mgrB. We describe for the first-time from India, insertional inactivation of mgrB by ISKpn14 inserted at different sites, responsible for colistin resistance.

Rev Esp Quimioter 2018; 31(5):406-410 [Full-text PDF]

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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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