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Rev Esp Quimioter 2017; 30(6): 429-435

Evolution of the Complexity Index of the antiretroviral therapy in HIV+ patients in a real life clinical practice

MERCEDES MANZANO-GARCÍA, AGUAS ROBUSTILLO-CORTÉS, CARMEN VICTORIA ALMEIDA-GONZÁLEZ, RAMÓN MORILLO-VERDUGO

Introduction. HIV infection has been one of the biggest successes in the healthcare world, mainly due to the appearance of antiretroviral treatment (ART). The complexity of this type of treatment has been one of the decisive factors in the follow-up of these patients.
Methods. An analytical, unicentric, retrospective observational study. We included all patients older than 18 years of age who were diagnosed with HIV who received ART in follow-up for the consultation of pharmaceutical pathology care during the year 2015. The evolution of the complexity index of ART over time and its relation with adherence to ART and concomitant treatment.
Results. A total of 619 patients were included in the study with a mean age of 47.03 ± 10.18 years. There was a reduction in CI over the years, with a significant decrease in the year 2013 and in 2015. The results obtained after the analysis of the secondary variables showed a significant relation between the adhesion to the ART and the CI of this. Patients have a lower CI (3.5) than non-adherent patients (4.25). (P = 0.003).
Conclusions. The complexity of ART is being reduced mainly by new treatment strategies and the increasing appearance of pharmaceutical coformulations. A reduction in the complexity of ART assumes a better adherence to it.

Rev Esp Quimioter 2017; 30(6): 429-435 [Texto completo PDF]

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Rev Esp Quimioter 2017; 30(6): 450-457

Useful independent factors for distinguish
infection and colonization in patients with urinary carbapenemase-producing Enterobacteriaceae isolation

LAURA LÓPEZ-GONZÁLEZ, FRANCISCO JAVIER CANDEL, JOSÉ MANUEL VIÑUELA-PRIETO, JUAN MARÍA GONZÁLEZ-DEL CASTILLO, ANA BELÉN GARCÍA, IRENE PENA, ICIAR RODRÍGUEZ-AVIAL

Objective. The aim of this study is to know epidemiologic and clinical differences among those patients colonized or infected by carbapenemase-producing Enterobacteriaceae (CPE) and develop a predictive model to facilitate the clinical approach concerning to start antimicrobial therapy.
Methods. Observational retrospective cohort study was performed involving all patients with Urine carbapene-mase-producing Enterobacteriaceae isolation (UCPEI) between November 2013 and July 2015. Patients were classifieds as colonized or infected considering Center for Disease Control and Prevention (CDC) definition for urinary tract infection (UTI).
Results. A total of 72 patients were included, mean age 76.4 (IQR 23-99) years and 40 (55.6%) were women. Thirty-four (47.2%) were colonized and 38 (52.8%) met the criteria of UTI and were considered infected. The independent variables associated to infection were female sex, peripheral vascular disease, admission in medical ward, permanent urinary catheter carrier, previous antimicrobial therapy, and length of stay. Isolation of OXA-48 carbapenemase-producing Enterobacteriaceae behaved as a non UTI (colonization) factor in comparison with KPC or VIM CPE. The developed predictive model showed an area under the curve (AUC) of 0.901 (95% CI: 0.832-0.970; p < 0.001).
Conclusion. The predictive model that includes all this factors has demonstrated a good accuracy for infection diagnosis in these patients, an important issue considering that establishing the diagnosis of infection is not always easy in the profile of patients in which a CPE is isolated.

Rev Esp Quimioter 2017; 30(6): 450-457 [Full-text PDF]

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Rev Esp Quimioter 2017; 30(6): 422-428

BAHNG score: predictive model for detection of subjects with the oropharynx colonized by uncommon microorganisms

JUAN GONZÁLEZ-DEL CASTILLO, JUAN TEJA-MARINA, FRANCISCO JAVIER CANDEL, JOSÉ BARBERÁN, ÁLVARO MORENO-CUERVO, FLAVIA CHIARELLA, LAURA LÓPEZ-GONZÁLEZ, PRIMITIVO RAMOS-CORDERO, FRANCISCO JAVIER MARTÍN-SÁNCHEZ

Objective. Pneumonia is most frequently produced by the microaspiration of flora that colonizes the oropharynx. Etiological diagnosis of pneumonia is infrequent in clinical practise and empirical treatment should be prescribed. The aims of the present study were to determine the factors associated with oropharynx colonization by uncommon microorganisms (UM) and to develop a predictive model.
Methods. A cross-sectional study that included all pa-tients living in one long-term care facilities was developed. Demographic, comorbidities, basal functional status and clinical data were collected. To determinate the oropharyngeal colonization, a single sample of pharynx was obtained for each subject using a cotton swab.
Results. A total of 221 subjects were included, mean age 86.27 (SD 8.05) years and 157 (71%) were female. In 32 (14.5%) subjects UM flora was isolated, Gram-negative bacilli in 16 (7.2%) residents, and Staphylococcus aureus in 16 (7.2%). The predictive model included the presence of hypertension, neuromuscular disease, Barthel < 90 and use of PEG. The BAHNG score (BArthel, Hypertension, Neuromuscular, Gastrostomy), showed an area under the curve of 0.731 (CI 95% 0.643-0.820; p<0.001). We have classified patients according to this score in low (0-2 points), intermediate (3-5 points) and high risk (≥ 6). The probability of UM colonization in the oropharyngeal based on this classification is 4.1%, 15.8% and 57.1% for low, intermediate and high risk, respectively.
Conclusion. The BAHNG score could help in the identifications of elderly patients with high risk of colonization by UM. In case of pneumonia the evaluation of the subject through this score could help in the initial decisions concerning antibiotic treatment.

Rev Esp Quimioter 2017; 30(6): 422-428 [Full-text PDF]

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Rev Esp Quimioter 2017; 30(6): 397-406

Update on management of invasive candidiasis

FRANCISCO JAVIER CANDEL, CARMEN PAZOS PACHECO, ISABEL RUIZ-CAMPS, EMILIO MASEDA, MARIA DEL ROSARIO SÁNCHEZ-BENITO, ANA MONTERO, MIREIA PUIG, FERNANDO GILSANZ, JUAN AGUILAR, MAYRA MATESANZ

Given the growing incidence of invasive candidiasis in critically ill and haemato-oncological patients and its poor outcomes, an early diagnosis and treatment are need for get a better prognosis. This document reviews the current approaches that help in diagnosis of invasive candidiasis based on culture-independent microbiological tests. The combination of clinical prediction scores with fungal serological markers could facilitate the approach in antifungal therapy, optimizing it. This article also reviews the epidemiology and primary risk factors for invasive candidiasis in these patients, updating the therapeutic approach algorithms in both clinical contexts based on the main evidence and international guidelines.

Rev Esp Quimioter 2017; 30(6): 397-406 [Full-text PDF]

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Rev Esp Quimioter 2017; 30(6):391-396

Mechanisms of resistance to daptomycin in Staphylococcus aureus

NATALIA GÓMEZ CASANOVA, MARÍA SILLER RUIZ, JUAN LUIS MUÑOZ BELLIDO

Daptomycin is a cyclic lipopeptide active against multidrug-resistant Gram-positives, including methicillin-resistant Staphylococcus aureus (MRSA) and S. aureus with reduced susceptibility to vancomycin. It is 4-8 fold as active as vancomycin against methicillin-susceptible S. aureus (MSSA) and MRSA, and retains most of this activity against S. aureus with reduced susceptibility to vancomycin.  The mechanism of action of daptomycin is not fully understood. Daptomycin binds to the bacterial cytoplasmic membrane, leading to depolarization due to the loss of potassium ions from the cytoplasm. Daptomycin non-susceptibility is unusual in the clinical setting. Different mechanisms have been proposed to explain daptomycin-resistance, most of them associated to changes in composition, charge and fluidity of the cell wall. The mprF mutations, which lead to an increase in the lysyl-phosphatidyl glycerol production, and rpoB and rpoC mutations (rpo genes encode for bacterial RNA polymerase subunits) have been proposed as associated to daptomycin-resistance, but a number of mutations in other genes ( walK, cls, ggrA…) have been proposed.

Rev Esp Quimioter 2017; 30(6):391-396 [Full-text PDF]

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Rev Esp Quimioter 2017, 30(5): 355-367

Candidemia and invasive candidiasis approach in critically ill patients: role of the echinocandins

BENITO ALMIRANTE, JOSÉ GARNACHO-MONTERO, EMILIO MASEDA, FRANCISCO JAVIER CANDEL, SANTIAGO GRAU, JESÚS GUINEA, IGNACIO MORENO, PATRICIA MUÑOZ, SERGIO RUIZ-SANTANA

Introduction. Invasive infections caused by Candida spp. in critically ill patients may significantly worsen their prognosis, so it is of great importance to establish an early detection and a suitable therapeutic strategy. The objective of this study was to define the differential role of echinocandins in treating certain critical patient profiles.
Methodology. A scientific committee of 9 experts in infectious diseases, critical care, microbiology, and hospital pharmacy reviewed the existing evidence on the treatment of candidemia and invasive candidiasis in critically ill patients. After that, a questionnaire with 35 items was elaborated to be agreed by 26 specialists in the aforementioned disciplines using a modified Delphi method.
Results. After two rounds of evaluation, a consensus was reached in terms of agreement in 66% of the items. Some of the consensuses achieved included: it is not necessary to adjust the dose of echinocandins during renal replacement therapy; the echinocandins are the empirical and/or directed treatment of choice for candidemia and invasive candidiasis associated with biofilms; these drugs may be used in the antifungal prophylaxis of high-risk liver transplantation. In the absence of additional clinical data, it should be noted that micafungin is the echinocandin with the most available scientific evidence.
Conclusions. The experts consulted showed a high degree of agreement on some of the most controversial aspects regarding the management of candidemia and invasive candidiasis in critical patients, which could inform of practical recommendations for their treatment.

Rev Esp Quimioter 2017; 30(5): 355-367 [Texto completo – PDF]

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Rev Esp Quimioter 2017, 30(5): 312-318

Streptococcus agalactiae: prevention and vaccine development

ALBERTO PUERTAS-PRIETO, ANA LARA-OYA, CARMEN LIÉBANA MARTOS, JAVIER RODRÍGUEZ-GRANGER, FERNANDO COBO, ANTONIO SAMPEDRO, ANASTASIA PADILLA, JOSÉ GUTIÉRREZ-FERNÁNDEZ, SEBASTIÁN MANZANARES-GALÁN, MARINA CUETO-LÓPEZ, MANUEL ROSA-FRAILE, JOSÉ MARÍA NAVARRO-MARI

Streptococcus agalactiae, group B Streptococcus (SGB), is the most important cause of morbi-mortality among newborn population, and an important pathogen among immunossupressed adult patients. Despite the advances in the treatment and prevention of neonatal infections as a consequence of implementation of national and international recommendations for prevention of infection, there are still some improvements for the final control of the disease. In this sense, the vaccination against SGB could be an effective measure for the prevention of disease in those cases where intrapartum prophylaxis is not useful and in adult patients with risk factors for invasive infection due to SGB. This review summarizes the efforts made until now in order to establish the control of the infection, and brings some information on the current state-of-the art of vaccines against SGB, in which different strategies in their design have been used.

Rev Esp Quimioter 2017; 30(5): 312-318 [Texto completo – PDF]

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Rev Esp Quimioter 2017; 30(3): 224-228

Ceftolozane-tazobactam for the treatment of ventilator-associated infections by colistin-resistant Pseudomonas aeruginosa 

FRANCISCO ÁLVAREZ LERMA, ROSANA MUÑOZ BERMÚDEZ, SANTIAGO GRAU, MARÍA PILAR GRACIA ARNILLAS, LUISA SORLI, LLUIS RECASENS, MIQUEL MICO GARCÍA

The use of colistin for the treatment of multiresistant bacteria has led to the emergence of colistin-resistant strains of Gram-negative bacilli. Treatment of infections caused by these pan–drug-resistant bacteria is difficult owing to the paucity of effective antibiotics. We report two cases of ventilator-associated respiratory infection caused by pan–drug-resistant, colistin-resistant Pseudomonas aeruginosa that were successfully treated with ceftolozane-tazobactam.

Rev Esp Quimioter 2017; 30(3): 224-228 [pdf]
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Rev Esp Quimioter 2017, 30(4):293-296

Post-exposure prophylaxis against HIV, do we use our resources appropriately?

ROSA ESCUDERO-SÁNCHEZ, CHRISTIAN J. KURT MEIER-DE-TABOADA, EMMA BARTOLOME-GARCÍA, PATRICIA M. RODRÍGUEZ-DE-BETHENCOURT-SANJUAN, JUAN EMILIO LOSA-GARCÍA

Introduction. Post-exposure prophylaxis (PEP) against human immunodeficiency virus can be occupational, non-occupational or vertical transmission. The aim of our study was to analyse the indication and treatment carried out in a hospital.
Methods. Retrospective observational study that included all patients who received PEP between 2006 and 2014. The project was approved by the Committee for Ethics in Clinical Research.
Results. We evaluated 54 PEP, which were started at 11.8 hours’ average. The antiretroviral drugs were adequately chosen, but the duration pattern did not adjusted to the recommendations published at that time. Tolerance was good, being gastrointestinal symptoms the most frequent adverse effects; only once was necessary to replace the pattern. There were usual losses during follow up, reaching in some subgroups 50%.
Conclusion. Indication and choice of drugs were adequate in the three kinds of contact risks, but monitoring should improve.

Rev Esp Quimioter 2017; 30(4):293-296 [pdf]
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Rev Esp Quimioter 2017, 30(4):285-292

Pleural effusion due to Parvimonas micra. A case report and a literature review of 30 cases

FERNANDO COBO, JAVIER RODRÍGUEZ-GRANGER, ANTONIO SAMPEDRO, LUIS ALIAGA-MARTÍNEZ, JOSÉ MARÍA NAVARRO-MARÍ

The clinical and microbiological characteristics of infections caused by Parvimonas micra is described, including 30 cases in the literature and a new case handled at the present centre. Out of the 31 patients, 18 were male; mean age at diagnosis was 65.1 ± 13.0 years. Infection site was the vertebral spine in 14 patients and joints and heart valves in 5 each one; pain was present in all patients with articular localization and in almost all patients with vertebral involvement. The diagnosis was obtained from fluid aspirate or drainage in 13 cases and blood cultures in 11. In 8 cases, molecular techniques were also applied. The most frequently used antimicrobials were clindamycin, penicillin, amoxicillin and ceftriaxone. The outcome was positive with the medical treatment in 28 patients. P. micra infections are uncommon and requires a high index of suspicion.

Rev Esp Quimioter 2017; 30(4):285-292 [pdf]
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