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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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Rev Esp Quimioter 2018; 31 (Suppl. 1): 23-26

Changes in bacterial hospital epidemiology

MARÍA ISABEL MOROSINI, RAFAEL CANTÓN

Antibiotics’ use and prescription requires a profound review, as their inadequate administration has been one of the main forces leading to resistance as a result of overuse and misuse. Resistance is particularly challenging in nosocomial environments in which there has been a gradual change in bacterial epidemiology owing to the continuous increase of multi-drug-resistant isolates, which imply a threat to prevent and cure infections. Expertise at the time of using antibiotics, development of new diagnostic tools and the possibility of having new antimicrobials are required to stay ahead of evolving
resistance. Moreover, surveillance is also relevant to monitor antimicrobial resistance.

Rev Esp Quimioter 2018; 31(Suppl. 1): 23-26 [Full-text PDF]

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Rev Esp Quimioter 2018; 31 (Suppl. 1): 1-8

Update in Infectious Diseases 2018

FRANCISCO JAVIER CANDEL, TEODOR EMILOV, IRENE DIAZ DE LA TORRE, ALBA RUEDAS, JOSE MANUEL VIÑUELA PRIETO, CARMEN VISIEDO, JORGE MARTÍNEZ-JORDÁN, LAURA LÓPEZ-GONZÁLEZ, MAYRA MATESANZ, ANA ARRIBI

VIII Updating Course of Antimicrobials and Infectious Diseases has reviewed useful microbiological, epidemiological and clinical aspects for a current approach of infectious pathology. Present manuscript summarizes a chronicle about the main infection related meetings during 2017 (ECCMID, IAS, ASM and ID Week). In addition, the course proposed a practical approach for understanding different type of pathogens and our selected topics this year were the epidemiology of bacterial nosocomial infection, a practical approach to Clostridium difficile infection patients, a two year selection of the top ten papers about fungal infection and an update in fungal biofilms. Finally, proffesors made a practical approach by main clinical syndromes like sepsis, infections in oncohematological patients, CNS infections in immunosuppressed patients and reviewed the top ten papers in transplant infectious diseases and infection control during the last two years.

Rev Esp Quimioter 2018; 31(Suppl. 1): 1-8 [Full-text PDF]

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Rev Esp Quimioter 2018; 31(5):386-405

Epidemiology of Q fever in Spain (2018)

JOSÉ LUIS PÉREZ-ARELLANO, CRISTINA CARRANZA RODRÍGUEZ, CARLOS GUTIERREZ, MARGARITA BOLAÑOS RIVERO

Q fever is an anthropozoonosis whose causative agent is Coxiella burnetii, which has an important impact from the human and animal health point of view. In this review, a brief historical reference of the infection by C. burnetii and Q fever has been made initially. In a second section the basic epidemiological aspects of this infection are described (reservoirs/ sources of infection, form of transmission and epidemiological forms). Subsequently, the data of the infection by C. burnetii in Spain will be are indicated, particularly the clinical series, the seroepidemiological studies in humans, the affectation of different types of mammals and the participation of the ticks in the biological cycle. In addition, basic data on C. burnetii infection/ disease in other regions of the world will be are also included. Finally, and taking into account the previous data will indicate the main epidemiological characteristics of Q fever at present.

Rev Esp Quimioter 2018; 31(5):386-405 [Texto completo PDF]

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Rev Esp Quimioter 2018; 31(4): 353-362

Staphylococcus aureus bacteremia in a secondary level Spanish hospital: clinical implications of high vancomycin MIC

GABRIELA ABELENDA ALONSO, MARÍA DOLORES CORBACHO LOARTE, RUTH NÚÑEZ RAMOS, MIGUEL CERVERO JIMÉNEZ, JUAN JOSÉ JUSDADO RUIZ-CAPILLAS

Background. One of the most controversial issues in recent years has been the clinical significance of high vancomycin MIC in Staphylococcus aureus bacteremia. The aim of this study was to elucidate the clinical implication that this parameter has in the staphylococcal bacteremia of a second level hospital.
Material and methods. Retrospective descriptive study between January 2014 and September 2016 with 138 records from the blood culture Severo Ochoa University Hospital registry. A total of 98 cases were finally analized. Microbiological analysis of vancomycin MIC was performed using micro dilution technique.
Results. The mean age was 71.4 ± 12.45 and 63.26% of the patients had a Charlson index ≥6. A 30.61% were carriers of a venous central catheter. The most frequent source was venous central catheter (26.53%). There were 14.24% metastatic events. Global mortality rate at 30 days was 25.51%. The 43.87% of strains had a vancomycin MIC ≥ 2 mg/L. High vancomycin MIC was significantly associated with persistent bacteremia (OR 3.12 [1.13-8.93]), maintaining this statistical significance in methicillin-resistant S. aureus (MRSA) group (p =0.001) but no in methicillin-susceptible S. aureus (MSSA) group (p = 0.13). Persistent bacteremia was also significantly related with permanent catheter carriers (OR 4.18 [1.38-12.61]), peripheric catheter source (OR 5.18 [1.13-8.93]) and metastatic complications (OR 3.82 [1.03- 12.81]). There was no significant association between high vancomycin MIC and mortality.
Conclusions. High vancomycin MIC may be useful in daily clinical practice as a marker of poor clearance of S. aureus bacteremia, specially when is due to MRSA strains.

Rev Esp Quimioter 2018; 31(4): 353-362 [Full-text PDF]

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Rev Esp Quimioter 2018; 31(4): 363-366

Seroprevalence of Toxoplasma gondii infection in pregnant women attending antenatal care in southern Ethiopia

JEMAL JULA, GUILLERMO GIRONES, BEYENE EDAO, CHALA DEME, JOSEFINA CEBRIAN, LIDIA BUTRÓN, FRANCISCO REYES, JOSÉ M. RAMOS

Objetives. The aim of the study was to assess the prevalence and possible risk factors of Toxoplasma gondii (toxoplasmosis) infection in pregnant women attending antenatal care at Gambo General Rural Hospital, southern Ethiopia.
Methods. Hospital-based, prospective cross-sectional study. We collected 401 serum samples from September 1 to October 30, 2015, along with sociodemographic data and data on potential risk factors, using a simple random sampling technique.
Results. The overall seroprevalence of T. gondii in pregnant women (mean age 23.1 years) was 23.9% (95% confidence interval [CI] 20.0, 28.3). We did not find any significant risk factors associated with seropositivity in relation with participants’ level of education; occupation; contact with cats; consumption of raw or uncooked meat, vegetables, or milk; or type of flooring (soil versus cement) at home. The women who were aware of the risk of toxoplasma infection on the fetus had fewer T. gondii antibodies. Drinking unsafe water was as-sociated with a higher risk of toxoplasmosis (p = 0.08).
Conclusion. The seroprevalence of toxoplasmosis among pregnant women was relatively lower.

Rev Esp Quimioter 2018; 31(4): 363-366 [Full-text PDF]

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Rev Esp Quimioter 2018; 31(4): 329-335

Changes in tuberculosis in human immunodeficiency virus infected patients in a Spanish tertiary hospital (1995-2013)

ANDRÉS GONZÁLEZ-GARCÍA, LORENA CARPINTERO, JESÚS FORTÚN, ENRIQUE NAVAS-ELORZA, PILAR MARTÍN-DÁVILA, SANTIAGO MORENO

Objectives. Although the incidence of human immunodeficiency virus (HIV)-associated tuberculosis (TB) has decreased, changes in other characteristics of the disease are largely unknown. To describe the trends in TB in patients infected with HIV from 1995 to 2013.
Methods. We review all cases of TB in a tertiary hospital in Madrid, Spain.
Results. Among 1,284 patients diagnosed of TB, 298 (23%) were coinfected with HIV. The prevalence of HIV infection during the period of study has decreased from 40% to 14% (p for the trend < 0.001). Clinical presentation has also changed. Although pulmonary and extrapulmonary TB has remained unchanged, miliary presentation has significantly decreased (from 36% to 22%, p = 0.005). The 4-drug regimen was the preferable scheme, with higher implementation at the end of the study period (82% from 1995-1999 to 95% in 2010-2013, p = 0.43). Factors such as treatment failure (OR: 11.7; CI 95%: 3.12-44.1) and miliary form (OR: 2.8; CI 95%; 1.09-7.3) were independently associated with TB related mortality, while the longer duration of treatment was as a protective factor (OR 0.7; CI 95%: 0.6-0.8).
Conclusions. HIV has decreased very significantly as a risk factor for the development of TB. Despite improvement in the treatment of both TB and HIV, and in overall mortality, deaths attributable to the disease in this population remain high mostly in miliary and relapsing forms.

Rev Esp Quimioter 2018; 31(4): 329-335 [Full-text PDF]

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Rev Esp Quimioter 2018; 31(4): 336-343

Role of Pneumocystis jirovecii in patients with different pulmonary underlying condition using a nested-PCR

LUCÍA MARTÍNEZ LAMAS, MARÍA TERESA PÉREZ RODRÍGUEZ, ISABEL ÁLVAREZ ÁLVAREZ, MARÍA EMILIA BOUZA SOAGE, MARÍA DEL PILAR FIGUEROA LAMAS, MAXIMILIANO ÁLVAREZ FERNÁNDEZ

Introduction. The prevalence of Pneumocystis jirovecii colonization and its role in pulmonary disease remains unclear. PCR methods have shown an improved sensitivity in the detection of this fungus. It has been suggested that the PCR results be combined with another test such as IFA to create a diagnostic algorithm.
Material and methods. A multiplex nested-PCR procedure with a 16S rRNA gene as the internal amplification control was evaluated to determine the role of P. jirovecii in pulmonary disease.
Results. A 20% of the 199 bronchoalveolar lavage samples were PCR-positive, 13.5% samples were PCR-inhibited, and the rate of Pneumocystis-colonisation was 6.4%. The sensitivity, specificity, positive predictive value and negative predictive value of the nested-PCR were 100%, 93%, 70% and 100%, respectively. The sensitivity of the nested-PCR was higher than the current “gold standard” immunofluorescence assay (IFA) (p< 0.0001). PCR-negative and PCR-positive patients did not show any clinical or radiological differences in the medical variables studied.
Conclusion. PCR could help the diagnosis of Pneumocystis pulmonary disease given the high negative predictive value of the technique. P. jirovecii DNA can frequently be detected in healthy population, so the analysis of the patient medical history is critical to make the correct clinical decision.

Rev Esp Quimioter 2018; 31(4): 336-343 [Full-text PDF]

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