Introduction. The importance in human diarrhoeal disease of Hafnia alvei is unclear. The objective of the study was to describe the population which was isolated H. alvei in stool cultures and the therapeutic management of these cases in our Health Area.
Material and methods. A descriptive retrospective study was carried out in 2014 and 2015. Epidemiological, clinical, treatment and evolution variables were collected in the computerized clinical history.
Result. A collection of 7,290 stool specimens were processed, 3,321 in 2014 and 3,969 in 2015, of which 58 (1.7%) and 53 (1.3%) were positive for H. alvei, respectively. A 60.4% of samples were isolated in women. The mean age was 38.68 years. A 68.5% of samples were from primary care. In 71.2% there was related clinic, diarrhoea in 57.7%. In 75.7% of the cases there was not associated underlying disease. A 43.2% of the cases received treatment. A 66.7% of treated patients came from Primary Care. The mean duration of treatment was 8 days. The evolution was favourable in 85.4% of the cases treated. All strains were susceptible to ciprofloxacin and trimethoprim/sulfamethoxazole.
Conclusions. More evidence is needed to support H. alvei as a cause of gastroenteritis.

Rev Esp Quimioter 2017; 30(4):280-284 [pdf]

JUAN MARCO FIGUEIRA-GONÇALVES, NATALIA BETHENCOURT-MARTÍN, LINA INMACULADA PÉREZ-MÉNDEZ, DAVID DÍAZ-PÉREZ, CRISTINA GUZMÁN-SÁENZ, PEDRO VIÑA-MANRIQUE, ARTURO JOSÉ PEDRERO-GARCÍA

Introduction. One of the major microorganisms described as the cause of exacerbations of chronic obstructive pulmonary disease (COPD) is Streptococcus pneumoniae. The aim of this study is to evaluate the impact of 13-valent pneumococcal conjugate polysaccharide vaccine (PCV13) in COPD patients with regard to the development of exacerbations and the possible differential effect according to the patient’s phenotype.
Material and methods. Prospective observational study of patients with COPD and FEV1 ? 65% and 18-month follow-up. Main variables: vaccination status with PCV13, phenotype “exacerbator” or “non-exacerbator”, number of exacerbations, hospitalization and deaths. A descriptive statistical analysis was performed according to the nature of the variable and an inferential analysis with CI95%, bivariate contrasts, and multivariate analysis. Significance level 5%. The statistical packages EPIDAT 3.0 and SPSS version 21.0 were used.
Results. 121 patients were included. Twenty-four percent were labeled as phenotype exacerbator. 36% were vaccinated with PCV13. During follow-up, 68% of patients had at least one exacerbation and 27% required hospitalization. We observed similarity (p> 0.05) in the number of exacerbations and deaths; however, the percentage of hospitalization in the vaccinated was 18%, compared to 32% in the non-vaccinated group. In the multivariate adjustment (controlling for the phenotype), an adjusted OR of 2.77 risk of hospitalization was observed in the non-vaccinated group (p = 0.044).
Conclusions. Non-vaccination with PCV13 almost triples the risk of hospitalization in patients with COPD.

Rev Esp Quimioter 2017; 30(4):269-275 [pdf]

LOURDES VÁZQUEZ LÓPEZ, TERESA VILLAESCUSA DE LA ROSA, RAFAEL DE LA CÁMARA, ILDEFONSO ESPIGADO, SANTIAGO GRAU CERRATO, MANUEL JURADO, MONTSERRAT ROVIRA, MIGUEL SALAVERT, DAVID SERRANO SIMONNEAU, CARLOS SOLANO VERCET, ISABEL RUIZ CAMPS

Introduction. Invasive fungal disease (IFD) is an important cause of morbidity and mortality in haematological patients. Antifungal prophylaxis (AFP) is indicated for a number of clinical scenarios in this group of patients. The aim of this study was to reach a consensus on IFD prophylaxis in haematological patients in order to optimize their management.
Methods. A committee of experts in haematology and infectious diseases compiled a survey of 79 items with controversial aspects about antifungal prophylaxis in haematological patients. The survey was evaluated in two rounds by a panel of experts following a modified Delphi methodology.
Results. Forty-four experts in haematology and infectious diseases answered the survey. After two evaluation rounds, consensus was reached in 67 of the 79 items (84.8%), specifically 48 items were consensually agreed on (60.7%) and 19 were disagreed on (24.0%). Consensus was reached on prophylaxis candidates profiles and questions related to indications, mechanisms of action, spectrum of activity, toxicity and interactions of antifungal were elucidated. The usefulness of micafungin in IFD prophylaxis was particularly analysed. The consensus reached was that micafungin is an antifungal to be considered in this context as its safety profile and lower interaction potential may be advantageous.
Conclusions. A broad consensus was found in the management of IFD prophylaxis in the haematological patient. This consensus provides practical indications about its optimal management and can help determine the profile of patients eligible for this type of intervention.

Rev Esp Quimioter 2017; 30(3): 213-223 [pdf]

ANA FERNÁNDEZ-VERDUGO, JAVIER FERNÁNDEZ, DOLORES ESCUDERO, LUIS COFIÑO, LORENA FORCELLEDO, MAURICIO TELENTI, EMILIO GARCÍA-PRIETO, RAQUEL RODRÍGUEZ-GARCÍA, LAURA ÁLVAREZ-GARCÍA, ANA PÉREZ-GARCÍA, CARLOS RODRÍGUEZ-LUCAS, FERNANDO VAZQUEZ

Introduction. Multidrug resistant (MDR) microorganisms represent a threat for patients admitted in Intensive Care Units (ICUs). The objective of the present study is to analyse the results of epidemiological surveillance cultures for these microorganisms in one of these units.
Material and methods. General ICU. Retrospective analysis, descriptive statistics. Analysis of epidemiological surveillance cultures for MDR microorganisms in 2015. Studied microorganisms: Methicillin-resistant Staphylococcus aureus (MRSA), ESBL-and/or carbapenemase-producing Klebsiella pneumoniae (CESBL-KP) and MDR Acinetobacter baumannii (MDRAB).
Results. One thousand, two hundred and fifty nine patients admitted. A total of 2,234 specimens from 384 patients were analysed (690, 634, 62 and 286 were rectal, throat, nasal and skin swabs respectively). Global APACHE II was 18.3 ± 8 versus 21.7 ± 7.8 in patients colonized/infected on admission. Global mortality was 19.7% versus 22.3% in patients colonized/infected on admission. The higher sensitivities achieved with the different samples for the different microorganism detection were as follows. MRSA: 79% and 90% for nasal and nasal + throat swabs, respectively. MDRAB: 80% and 95% for throat and throat + rectal swabs, respectively. CESBL-KP: 95% and 98% for rectal and rectal + throat swabs, respectively. 94 out of the 384 patients (24.4%) were colonized/infected with MDR at admission. 134 patients (10.6% of the total patients admitted) were colonized/infected with a total of 169 MMR during the hospital stay. MRSA has the earliest colonization/infection (9.2 ± 6.4days) and ESBL-producing Enterobacteriaceae, the latest (18.7± 16.4 days).
Conclusions. 24.4% of patients were colonized/infected by MDR at admission. Nasal, throat and rectal swabs were the most effective specimens for recovering MRSA, MDRAB and CESBL-KP, respectively. The combination of two specimens improves MDR detection except for CESBL-KP. Skin swabs are worthless. The most prevalent MDR at admission were ESBL-producing Enterobacteriaceae while the most frequent hospital acquired MDR was MDRAB.

Rev Esp Quimioter 2017; 30(3): 201-206 [pdf]

JUDITH ÁLVAREZ-OTERO, JOSE LUIS LAMAS-FERREIRO, LUCÍA GONZÁLEZ-GONZÁLEZ, IRENE RODRÍGUEZ-CONDE, MARÍA JOSÉ FERNÁNDEZ-SONEIRA, ALEXANDRA ARCA-BLANCO, JOSE RAMÓN BERMÚDEZ-SANJURJO, JAVIER DE LA FUENTE-AGUADO

Introduction. Pseudomonas aeruginosa is a non-fermentative gram-negative bacillus with a great ability to develop resistance to multiple antibiotics, including carbapenems, which is a growing problem worldwide. The aim of this study was to analyse the prevalence of carbapenem-resistant P. aeruginosa (CRPA) in urine cultures and to determine the risk factors associated with the development of carbapanem resistance.
Material and method. Positive urine cultures to P. aeruginosa between September 2012 and September 2014 were identified. We excluded repetitive cultures from the same patient. We created a database with different variables, including antimicrobial resistance. The prevalence of carbapenem resistance and the risk factors for growth of CRPA were analysed.
Results. Ninety-one patients with positive urine cultures to P. aeruginosa were included. The prevalence of CRPA was 22%. The risk factors to CRPA infection in the univariate analysis were: congestive heart failure (p=0.02), previous treatment with ampicillin (p=0.04), meropenem (p=0.04), piperacillin-tazobactam (p=0.01), trimethoprim-sulfamethoxazole (p= 0.01) and previous treatment with more than one antibiotic (p<0.01). Only congestive heart failure (p<0.01) and previous treatment with more than one antibiotic (p<0.01) showed statistically significant differences in the multivariate analysis. Conclusions. The prevalence of CRPA in urine cultures is high in our population. We should assess the presence of risk factors as previous treatment with more than one antibiotic or comorbidities such as heart failure, in order to select an appropriate empirical treatment in patients with severe urinary tract infections.

Rev Esp Quimioter 2017; 30(3): 183-194 [pdf]