Rev Esp Quimioter 2016, 29(4):206-213

Changes in the epidemiology of Clostridium difficile infection during 2005-2014 in Salamanca, Spain                    

OLAIA CORES-CALVO, ENRIQUE GARCÍA-SÁNCHEZ, LUIS FÉLIX VALERO-JUAN, JOSÉ ELÍAS GARCÍA-SÁNCHEZ, MARÍA INMACULADA GARCÍA-GARCÍA          

Background. To know the most relevant epidemiological features of Clostridium difficile infection (CDI) between 2005- 2014 in the province of Salamanca (Spain).
Methods. Descriptive cross-sectional study carried out through review of the clinical microbiologic records at Complejo Asistencial Universitario de Salamanca. Detection was performed according to standard methodology.
Results. 2.6% of stool samples analyzed for detection of C. difficile toxins (9,103) were positive. The average prevalence was 6.8 cases per 100,000 people per year. The mean age was 65 ± 21.4 years and the median 70 years. 59% of cases occurred in patients over 64 years, with an average prevalence of 16.5 (4 times higher than the 15-64 group). Most cases (86.4%) occurred in hospitalized patients, and the group of over 64 had the highest percentage of hospital CDI, with 55%.
Conclusions. A significant increase in the number of requests and in the prevalence of CDI over the decade studied is observed, and prevalence rates were significantly lower than those of other studies. The percentage of CDI increased significantly in both inpatient and community. Age and hospitaliza-tion were risk factors for developing CDI. After the introduc-ion of a molecular detection technique in 2014, the prevalence increased, being 2.5 times higher than 2013.

Rev Esp Quimioter 2016; 29(4):206-213 [pdf]

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Rev Esp Quimioter 2016, 29(Suppl. 1):35-38

Multidrug-resistant tuberculosis: current epidemiology, therapeutic regimens, new drugs                     

CRISTINA GÓMEZ-AYERBE, MARÍA JESÚS VIVANCOS, SANTIAGO MORENO          

Multidrug and extensively resistant tuberculosis are especially severe forms of the disease for which no efficacious therapy exists in many cases. All the countries in the world have registered cases, although most of them are diagnosed in resource-limited countries from Asia, Africa and South America. For adequate treatment, first- and second-line antituberculosis drugs have to be judiciously used, but the development of new drugs with full activity, good tolerability and little toxicity is urgently needed. There are some drugs in development, some of which are already available through expanded-access programs.

Rev Esp Quimioter 2016; 29(Suppl. 1):35-38 [pdf]

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Rev Esp Quimioter 2016, 29(6):318-327

Key issues in the infected patient care in the Emergency Department                     

FLAVIA CHIARELLA, JUAN GONZÁLEZ-DEL CASTILLO, FRANCISCO JAVIER CANDEL, ERIC JORGE GARCÍA- LAMBERECHTS, MARÍA JOSÉ NÚÑEZ-ORANTOS, FRANCISCO JAVIER MARTÍN-SÁNCHEZ REPRESENTING THE INFECTIOUS DISEASE GROUP OF SPANISH EMERGENCY MEDICINE SOCIETY          

Objective. To develop a set of recommendations, by consensus of Emergency Medicine experts, on key aspects related to the care of adult patients with acute infection attended in Spanish emergency departments (ED).    
Methodology. The study was divided into three phases: 1) To design a questionnaire by a coordinating group; 2) To conduct a survey in ED physicians in order to know their opinion on the issues raised by the coordinating group; 3) To develop a number of recommendations based on the responses to the questionnaire and their subsequent discussion.
Results. A group of 28 experts from different Spanish ED, as well as 5 members of the coordinating group, with knowledge and experience in the management of infectious diseases in ED, conducted a round of voting to a questionnaire of 18 issues grouped into three sections: 1) identification and stratification of the severity; 2) diagnosis and treatment; 3) management.   
Conclusions. A monitoring system and proper training of the entire healthcare team are required, as well as extensive knowledge on these issues, to ensure adequate and effective care for these patients. It is essential to educate and train all health staff, especially in the ED, because it is the initial point of contact for most patients with an infection. The experts established proposals based on survey questions and the discussion.

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Rev Esp Quimioter 2017, 30(2):103-117

Delphi-based study and analysis of key risk factors for invasive fungal infection in haematological patients                     

LOURDES VÁZQUEZ, MIGUEL SALAVERT, JORGE GAYOSO, MANUEL LIZASOAÍN, ISABEL RUIZ CAMPS, NICOLÁS DI BENEDETTO, ON BEHALF OF THE STUDY GROUP OF RISK FACTORS FOR IFI USING THE DELPHI METHOD           

Introduction. Mortality caused by invasive fungal infections due to filamentous fungi (IFI-FF) is high. Predisposing factors to IFI-FF are multiple and should be stratified. The objective of this study was to identify key risk factors for IFI-FF in onco-haematological patients in different clinical settings.
Methods. Prospective national Delphi study. Risk factors for IFI-FF in patients with onco-haematological diseases were identified by a systematic review of the literature. An anonymous survey was sent by e-mail to a panel of experts. A key risk factor was defined when at least 70% of the surveyed participants assigned a “maximal” or “high” risk.
Results. In allogenic stem cell transplantation, 18 of the 42 risk factors analyzed were classified as key risk factors, including neutropenia, previous IFI-FF, grade III/IV acute or extensive chronic graft-versus-host disease (GVHD), umbilical cord blood transplantation, HLA mismatching transplantation, graft failure, absence of HEPA filters, absence of laminar air  flow, diagnosis of acute myeloid leukaemia, haploidentical transplantation, anti-TNF-α drugs, alemtuzumab, anti-thymocyte globulin, immunosuppressive prophylaxis for GVHD, lymphocytopenia, cytomegalovirus infection, and proximity to construction areas. In acute leukaemia/myelodysplastic syndrome (AL/MDS), 7 of 25 risk factors were defined as key risk factors, including neutropenia, consolidation therapy without response, induction therapy, antifungal prophylaxis with azoles, proximity to construction areas, and absence of HEPA filters. In lymphoma/multiple myeloma (MM), the five key risk factors among 21 analyzed were use of steroids, neutropenia, progressive disease, anti-CD52 therapies, and proximity to construction areas.
Conclusions. The Delphi method was useful for the classification and stratification of risk factors for IFI-FF in patients with onco-haematological diseases. Identifying key risk factors will contribute to a better management of IFI-FF in this group of patients at high or changing risk.

Rev Esp Quimioter 2017; 30(2):103-117  [pdf]

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Rev Esp Quimioter 2015:28(3):145-153

Profiles and clinical management of hepatitis C patients in Spain: disHCovery study                                 
 


MARÍA BUTI, ALEJANDRO FRANCO, ISABEL CARMONA, JUAN JOSÉ SÁNCHEZ-RUANO, ANDREU SANSÓ, MARINA BERENGUER, LUISA GARCÍA-BUEY, MANUEL HERNÁNDEZ-GUERRA, ROSA MARÍA MORILLAS, FRANCISCO LEDESMA, RAFAEL ESTEBAN, AND THE DISHCOVERY STUDY GROUP              

 

Introduction. To assess the clinical profile and management of patients with hepatitis C (HCV) infection in an observational study in Spanish hospitals.
Methods. The study included an initial cross-sectional phase (study phase I), in which investigators at 48 hospitals from 14 Spanish regions collected data from approximately 20 consecutive patients each (a total of 1,000 patients) to assess the general features of HCV-infected patients of any genotype. During the second phase (study phase II), data from 878 patients that were infected exclusively with genotype 1 HCV were assessed retrospectively. Eight pre-defined clinical profiles were established, in order to assess clinical and previous treatments characteristics.
Results. Among the HCV-infected individuals that were analysed during the first part, HCV genotype 1 was found to be predominant (with a prevalence of 76.6%), prevailing the subtype 1b (69.8%), with other significant groups infected by genotype 3 (12.3%) and 4 (7.4%). In the second part of the study, 44% of the HCV genotype 1-infected patients were at a F3/F4 fibrosis stage. 15.9% had never been treated, and previously unsuccessfully treated patients that were no longer receiving anti-HCV treatment accounted for 50.8% of cases. Individuals with a sustained virologic response (SVR) to pre-vious dual therapies (based on Interferon and Ribavirin) were only 14.5% and patients under treatment during the study accounted for the remaining 18.8%. A total of 713 patients (81.2%) in the second phase were not receiving any type of therapy over the period analysed, mainly due to the anticipation of new anti-HCV drugs (41.8%), SVR achievement (17.8%) and unresponsiveness to therapies available at the time of the study (9.5%).
Conclusions. HCV genotype 1, predominately 1b, is the most prevalent type in Spain. Advanced fibrosis or cirrhosis is frequent in this group, mainly patients not yet cured.

Rev Esp Quimioter 2015:28(3):145-153 [pdf]

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Rev Esp Quimioter 2015:28(Suppl. 1):25-29

Cloxacillin-susceptible Staphylococcus aureus with high MIC to glycopeptides. Ever we use cloxacillin?     

                        
ALEJANDRA MORALES, ANTONIO LALUEZA, RAFAEL SAN JUAN, JOSÉ MARÍA AGUADO              

Staphylococcus aureus infections are yet an important cause of morbidity and mortality despite of numerous effective anti-staphylococcal antibiotics available. There has been an increasing incidence of methicillin-resistant strains which might have led to a wider use of vancomycin. This seems to ride alongside a covert progressive increase of S. aureus vancomycin minimum inhibitory concentration. In this way, the emergence of vancomycin-intermediate S. aureus (VISA) strains and heteroresistant-VISA has raised concern for the scarcity of alternative treatment options. Equally alarming, though fortunately less frequent, is the emergence of vancomycin-resistant S. aureus. Ultimately, various debate issues have arisen regarding the emergence of S. aureus strains with decreased vancomycin susceptibility, within the range still considered sensitive. These strains have shown a different clinical behaviour regardless of vancomycin use, both in methicillin resistant and sensitive S. aureus. The emergence of increasing vancomycin-resistance in S. aureus isolates, has stirred up the basis of therapeutic approach in staphylococcal infections. There is yet much to explore to better define the impact of higher vancomycin minimum inhibitory concentration in staphylococcal infections.

Rev Esp Quimioter 2015:28(Suppl. 1):25-29 [pdf]

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Rev Esp Quimioter 2015:28(6):289-294

Surveillance of resistance of Staphylococcus aureus to antibiotics in Galicia: 2007-2012     

                        
MERCEDES TREVIÑO, ISABEL LOSADA, MARÍA ÁNGELES PALLARÉS, FRANCISCO JOSÉ VASALLO, AMPARO COIRA, BEGOÑA FERNÁNDEZ-PÉREZ, ISABEL PAZ, FERNANDA PEÑA, PATRICIA ALEJANDRA ROMERO, LUCÍA MARTÍNEZ-LAMAS, GAEL NAVEIRA, XURXO HERVADA              

Introduction. Since 2007 the Galician Surveillance Program on Antimicrobial Resistance has been collected data of Staphylococcus aureus susceptibility patterns. The data from 2007 to 2012 have been analyzed and are reported.
Methods. A total of 4,577 different isolates of S. aureus from cerebrospinal fluid and blood cultures were included. The Institutions involved provided the information about the susceptibility patterns, the assay methods used and the interpretative guidelines followed, and demographic data of patients.
Results. The rate of methicillin-resistance S. aureus (MRSA) was 22% in 2007-2010 and 26% in 2011-2012, although in some areas the percentage reached 57% (2007- 2010) or 66% (2011-2012). The higher rates of resistance were found in patients older than 75 years. Gentamycin resistance was less than 9% and for quinolones were about 25%. A strong association between methicillin and quinolone-resistance were observed (91%). The resistance against linezolid and glycopeptides were exceptional.
Conclusions. The percentage of MRSA has evolved slightly along the period of this study reaching no significant differences between Galicia and the global data in Spain in 2012. Nevertheless, there are significant differences among the geographic areas studied. Most MRSA isolates were recovered from hospitalized patients, but an increase in the number of MRSA among outpatients was observed, while old patients from nur-sing homes are included in the outpatient group, so the MRSA rate in this group could be overestimated.

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Rev Esp Quimioter 2016, 29(2):91-98

Changes in the epidemiology of gastroenteritis caused by Salmonella during 2005-2014 in Salamanca, Spain    

                        

OLAIA CORES-CALVO, LUIS FÉLIX VALERO-JUAN, ENRIQUE GARCÍA-SÁNCHEZ, JOSÉ ELÍAS GARCÍA-SÁNCHEZ, MARÍA INMACULADA GARCÍA-GARCÍA             

Background. In Spain there are not many updated population studies about salmonellosis, despite being one of the most common etiologies of acute gastroenteritis (AGEs) caused by bacteria in the world. The aim of the study was to know the most relevant epidemiological features of AGEs produced by Salmonella spp. between 2005 and 2014 in Salamanca (Spain).
Methods. Descriptive cross-sectional study carried out through review of the clinical microbiologic records at Complejo Asistencial Universitario de Salamanca. Culture, isolation, identification and serotyping were performed according to standard methodology.
Results. Salmonella was isolated in 1,477 patients, representing 47.7% of all positive stool cultures and 53.3% of all income bacterial AGE. The average prevalence was 42.1 cases/100,000 people per year. The mean age was 23 ± 28 years and the median 7 years. 40.2% of all isolates occurred in children under 5 years, with an average prevalence of 45.1 cases/ 10,000 people per year. Overall, the most frequently isolated serotype was S. Typhimurium with 57%, followed by S. Enteritidis with 35.8%.
Conclusions. The prevalence of Salmonella decreased over time. The group aged 0-4 years had the highest rate throughout the period. However, Salmonella produced the highest percentage of hospitalizations for bacterial AGE. In recent years, S. Typhimurium serotype has replaced S. Enteritidis serotype and predominates in younger patients. It is observed under-reporting of cases of salmonellosis produced in Salamanca despite being mandatory notification of these since 2007.

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Rev Esp Quimioter 2016, 29(4):214-219

Tuberculous prosthetic knee joint infection: a case report and literature review                     

ANA LARA-OYA, Mª DEL CARMEN LIÉBANA-MARTOS, JAVIER RODRÍGUEZ-GRANGER,  ANTONIO SAMPEDRO-MARTÍNEZ, LUIS ALIAGA-MARTÍNEZ, JOSÉ GUTIERREZ-FERNÁNDEZ, JOSÉ Mª NAVARRO-MARÍ          

Introduction. Prosthetic late infection occurs in the second month after surgery in the context of haematogenous spread from another source. Prosthetic mycobacterial infection is a rare complication whose clinical management is not standardized.
Case. Patient of 77 years with no personal history except for diabetes and a prosthetic replacement of right knee with osteoarthritis three years ago.  Patient goes to hospital emergency box for 6 months pain in the right knee with mechanical inflammatory signs but no fever associated. After their return within 5 days and clinical worsening is reporting growth of Mycobacterium tuberculosis in knee aspirate and antitubercular treatment is established for 9 months. Nuclear magnetic resonance imaging studies also confirmed the diagnosis of tuberculosis spondylitis in the clinical context of the patients. After surgery, M. tuberculosis was again isolated from intraoperative samples and therefore the patient received another batch of treatment for 9 months. After a year of monitoring, the development was acceptable but few months later, the patient died for cardiovascular causes. In the literature review, 15 publications with a total of 17 clinical cases of prosthetic infection by M. tuberculosis were found from 1980 to 2014.    
Conclusion. Prosthetic tuberculous arthritis, although it is a rare presentation, it should be noted, especially in patients with predisposing conditions with a history of tuberculosis infection.

Rev Esp Quimioter 2016; 29(4):214-219 [pdf]

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Rev Esp Quimioter 2016, 29(Suppl. 1):39-42

Old and new antibiotics for therapy of multidrug resistant bacteria                     

VICENTE PINTADO          

The lack of new antibiotics for multidrug-resistant bacteria is a matter of concern in microorganisms such as Pseudomonas aeruginosa, ESBL- and carbapenemase-producing Enterobacteriaceae, Acinetobacter baumannii, methicillin-resistant Staphylococcous aureus and vancomycin-resistant Enterococcus faecium. This situation has conditioned the reuse of “old” antibiotics (colistin, fosfomycin), the use of more recent antibiotics with new indications or dosage regimens (tigecycline, meropenem) and the introduction of “new” antibiotics (β-lactams, lipoglycopeptides, oxazolidinones) that are the subject of this review.

Rev Esp Quimioter 2016; 29(Suppl. 1):39-42 [pdf]

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