Rev Esp Quimioter 2017; 30(3): 169-176

Strategies to optimize the use of antibiotics in hospitals
JOAQUÍN GÓMEZ, CRISTINA BONILLO, LUIS HUMBERTO NAVARRO, ALICIA HERNÁNDEZ, ELISA GARCÍA VÁZQUEZ
The inadequate use of antibiotics is a clinical reality we are faced with day by day. The great peculiarity of this group of drugs is the in?uence they have not only on the patients and at the time of their use, but also of future infections and the general population, by favoring alterations in the resistance patterns of the bacterial micro?ora that colonize people. It is our obligation as experts in infectious diseases to work on improving the use of antimicrobials.

Rev Esp Quimioter 2017; 30(3): 169-176 [pdf]
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Rev Esp Quimioter 2017, 30(4):257-263

Impact of a stewardship program on bacteraemia in adult inpatients

ESPERANZA MERINO, ELENA CARO, JOSÉ M. RAMOS, VICENTE BOIX, ADELINA GIMENO, JUAN CARLOS RODRÍGUEZ, GERÓNIMA RIERA, PATRICIO MÁS-SERRANO, JOSÉ SANCHÉZ-PAYA, SERGIO REUS, DIEGO TORRÚS, JOAQUÍN PORTILLA

Background. Bloodstream infections (BSIs) are associated with considerable morbidity and mortality among inpatients. The aim of this study was to evaluate the impact of a stewardship program on clinical and antimicrobial therapy-related outcomes in patients with bacteraemia.
Methods. Single-centre, before-and-after quasi-experimental study in adult inpatients. Over 1 January 2013 to 31 June 2013 all patients aged 18 years or older with a bacteraemia (interven-tion group, N=200) were compared to a historical cohort (1 Janu-ary 2012 to 31 December 2012) (control group, N=200).
Results. Following blood culture results and adjusting for potential confounders, the stewardship program was associated with more changes to antibiotic regimens (adjusted odds ratio [ORa]: 4.6, 95% CI 2.9, 7.4), more adjustments to antimicrobial therapy (ORa: 2.4, 95% CI 1.5, 3.8), and better source control in the first five days (ORa 1.6, 95% CI: 1.0, 2.7). In the subgroup that initially received inappropriate empiric treatment (n=138), the intervention was associated with more antibiotic changes (OR: 3.9, 95% CI: 1.8, 8.5) and a better choice of definitive antimicrobial therapy (OR 2.3 95% CI: 1.2, 4.6). There were also more antibiotic changes in the subgroups with both Gram-negative (OR: 2.8, 95% CI: 1.6, 4.9; n=217) and Gram-positive (OR: 4.6, 95% CI: 1.8, 9.9; n=135) bacteraemia among those receiving the intervention, while the Gram-positive subgroup also received more appropriate definitive antimicrobial therapy (OR: 3.9, 95% CI: 1.8, 8.8).
Conclusion. The stewardship program improved treatment of patients with bacteraemia and appropriateness of therapy.

Rev Esp Quimioter 2017; 30(4):257-263 [pdf]
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Rev Esp Quimioter 2017, 30(4):245-256

 

Usefulness of biomarkers to predict bacteraemia in patients with infection in the emergency department
AGUSTÍN JULIÁN-JIMÉNEZ, FRANCISCO JAVIER CANDEL, JUAN GONZÁLEZ-DEL CASTILLO, EN REPRESENTACIÓN DEL GRUPO INFURG-SEMES (GRUPO DE ESTUDIO DE INFECCIONES DE LA SOCIEDAD ESPAÑOLA DE MEDICINA DE URGENCIAS Y EMERGENCIAS)

Between all patients attended in the Emergency Department (ED), 14.3% have an infectious disease diagnosis. Blood cultures (BC) are obtained in 14.6% of patients and have a profitability of 20%, whereas 1% are considered as contaminated and 1-3% of positive cultures correspond to discharge patients (“hidden bacteraemia”). The highest number of confirmed bacteraemias comes from the samples of patients with urinary tract infections, followed by community-acquired pneumonia. The suspicion and detection of bacteraemia have an important diagnostic and prognostic significance and could modify some important making-decisions (admission, BC request, administration of appropriate and early antimicrobial, etc). Therefore, finding a predictive model of bacteraemia useful and applicable in ED has become the objective of many authors that combine different clinical, epidemiological and analytical variables, including infection and inflammatory response biomarkers (IIRBM), as they significantly increase the predictive power of such models. The aim of this review is to highlight the evidence showed in recent published articles, to clarify existing controversies, and to compare the accuracy of the most important IIRBM to predict bacteremia in patients attended due to infection in the ED. Finally, to generate different recommendations that could help to define the role of IIRBM in improving the indication to obtaining BC, as well as in immediate decision-making in diagnosis and treatment (early and adequate antibiotic treatment, complementary tests, other microbiological samples, hemodynamic support measures, need for admission, etc.).

Rev Esp Quimioter 2017; 30(4):245-256 [pdf]
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Rev Esp Quimioter 2017; 30 (Suppl. 1): 66-71

Non-antibiotic treatment for infectious diseases

JESÚS RUIZ, IVÁN CASTRO, EVA CALABUIG, MIGUEL SALAVERTI

The abuse and uncontrolled use of antibiotics has resulted in the emergence and spread of resistant bacteria. The utility of conventional antibiotics for the treatment of bacterial infections has become increasingly strained due to increased rates of resistance coupled with reduced rates of development of new agents. As a result, multidrug-resistant, extensively drug-resistant, and pan-drug-resistant bacterial strains are now frequently encountered. This has led to fears of a “post-antibiotic era” in which many bacterial infections could be untreatable. Alternative non-antibiotic treatment strategies need to be explored to ensure that a robust pipeline of effective therapies is available to clinicians. The new therapeutic approaches for bacterial infections (beyond antibiotics) may provide a way to extend the usefulness of current antibiotics in an era of multidrug-resistant (MDR) bacterial infections.

Rev Esp Quimioter 2017; 30 (Suppl. 1): 66-71 [pdf]
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Rev Esp Quimioter 2017; 30 (Suppl. 1): 61-65

Usefulness of Hospital at Home in nosocomial infections: advantages and limitations

VÍCTOR JOSÉ GONZÁLEZ RAMALLO, MANUEL MIRÓN RUBIO, ORIOL ESTRADA CUXART, MARÍA EUGENIA GARCÍA LEONI

Las unidades de Hospitalización a Domicilio permiten el tratamiento y control ambulatorio de infecciones graves y complejas. Las infecciones nosocomiales suponen una prolongación de la estancia hospitalaria precisando con frecuencia largos tratamientos intravenosos sin alternativa eficaz oral. Los antimicrobianos más sencillos de administrar en domicilio son aquellos con dosis única diaria. La utilización de bombas programables portátiles de infusión y de dispositivos elastoméricos permite infundir con eficacia y seguridad la mayoría de antimicrobianos. Algunos de los antibióticos frente a microorganismos multirresistentes de reciente introducción tienen un perfil muy adecuado para el tratamiento intravenoso ambulatorio.

Rev Esp Quimioter 2017; 30 (Suppl. 1): 61-65 [pdf]
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Rev Esp Quimioter 2017; 30 (Suppl. 1): 56-60

Optimizing antimicrobial prescribing: a practical decalogue

ESTELA MORENO-GARCÍA, JULIO GARCÍA RODRÍGUEZ, JOSÉ RAMÓN PAÑO-PARDO

Increasing antibiotic resistance is one of the leading problems in the Public Agenda worldwide. In the last 20 years, the pace of antimicrobial drug development has markedly slowed leading to a dramatic world situation. Infections with antibiotic-resistant microorganisms have been associated with increased length of stay, mortality and costs. Improving antimicrobial prescribing is one of the tools in our hands to optimize the outcomes of patients with moderate to severe infections and control the emerging of resistance. Several clues to improve antimicrobial prescribing are provided as a key-messages decalogue.

Rev Esp Quimioter 2017; 30 (Suppl. 1): 56-60 [pdf]
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Rev Esp Quimioter 2017; 30 (Suppl. 1): 48-51

New sepsis criteria: do they replace or complement what is known in the approach to the infectious patient?

JUAN GONZÁLEZ DEL CASTILLO, CARLOTA CLEMENTE, FRANCISCO JAVIER CANDEL, FRANCISCO JAVIER MARTÍN-SÁNCHEZ

There have recently been profound changes in both the definitions of sepsis and septic shock and the diagnostic criteria established for daily clinical practice. In addition, a new screening tool known as qSOFA has been introduced to identify patients at risk of a poor short-term outcome. This score has been accompanied by some controversy due to presenting a lower sensitivity than the systemic inflammatory response criteria previously used to identify such patients. In this article, we shall summarise and analyse the most important recently published studies in relation to these new criteria.

Rev Esp Quimioter 2017; 30 (Suppl. 1): 48-51 [pdf]
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Rev Esp Quimioter 2017; 30 (Suppl. 1): 42-47

Non-valvular intravascular device and endovascular graft-related infection

FRANCISCO CARMONA-TORRE, MARTA RUA, JOSÉ LUIS DEL POZO

In the last few years there has been an increase of implantable cardiac electronic device and vascular graft related infections. This is due in part to a higher complexity of some of these procedures and an increase in patient’s comorbidities. Despite wide diagnosis methods availability, early stage diagnosis usually constitutes a challenge as often patients only denote insidious symptoms. In most confirmed cases, removal of the infected device is required to resolve the infection. This is mostly explainable because of bacterial ability to grow as biofilms on biomaterial surfaces, conferring them antimicrobial resistance. If removal is not possible, chronic suppressive antimicrobial therapy could be an option.

Rev Esp Quimioter 2017; 30 (Suppl. 1): 42-47 [pdf]
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Rev Esp Quimioter 2017; 30 (Suppl. 1): 39-41

Urinary tract infections in inpatients: that challenge

VÍCTOR VÁSQUEZ, DAVID AMPUERO, BELÉN PADILLA

Urinary tract infection (UTI) is one of the major nosocomial infections. In more than 80% of cases it is related to the use of urological devices, especially linked to the misuse of urinary catheters. Empirical treatment should be based on local epidemiology,
severity criteria and risk of multiresistant bacteria. This review shows the most important aspects of nosocomial UTI, as well as the recommendations for correct treatment adjustment; both empirical and definitive, that is the great challenge to avoid multiresistance, as well as to avoid unnecessary treatments.

Rev Esp Quimioter 2017; 30 (Suppl. 1): 39-41 [pdf]
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Rev Esp Quimioter 2017; 30 (Suppl. 1): 34-38

Antimicrobial management in nosocomial peritonitis: microbiota, drug and time

ANA MONTERO, PATRICIA SALGADO ARANDA, FERNANDO GILSANZ, EMILIO MASEDA

Complicated intra-abdominal infection requires surgical treatment and broad-spectrum empiric antibiotic treatment used early. The rapid spread of multidrug-resistant bacteria has become a serious threat, especially in critical care units. The excessive use of carbapenems has led to carbapenemase-producing Enterobacteriaceae, leaving tigecycline and colistin as therapeutical options. The new antimicrobials, ceftazidime-avibactam and ceftolozane-tazobactam open new horizons in the treatment of multi-drug resistant Enterobacteriaceae. Candida peritonitis causes a high mortality in the critical patient. Diagnosis and early treatment are associated with a better prognosis, the administration of an echinocandin being of choice in these patients.

Rev Esp Quimioter 2017; 30 (Suppl. 1): 34-38 [pdf]
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