Rev Esp Quimioter 2017; 30 (Suppl. 1): 30-33

Empirical treatment of adults with hospital-acquired pneumonia: lights and shadows of the 2016 Clinical Practice ATS/IDSA Guidelines

MIGUEL VACAS-CÓRDOBA, CELIA CARDOZO-ESPINOLA, PEDRO PUERTA-ALCALDE, CATI CILLONIZ, ANTONI TORRES, CAROLINA GARCÍA-VIDAL

La neumonía nosocomial es una causa frecuente de infección intrahospitalaria y tiene una elevada morbilidad y mortalidad. En el año 2016 se ha publicado una nueva guía de práctica clínica para el manejo de la neumonía nosocomial en adultos, elaborada por la Infectious Diseases Societyof America (IDSA) y la American Thoracic Society (ATS). Esta revisión comenta nuestra opinión sobre las nuevas recomendaciones y sus limitaciones, así como en las nuevas opciones terapéuticas disponibles que podrían mejorar el tratamiento y pronóstico de estos pacientes.

Rev Esp Quimioter 2017; 30 (Suppl. 1): 30-33 [pdf]
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Rev Esp Quimioter 2017; 30 (Suppl. 1): 26-29

Comments on practice guidelines for the diagnosis and management of aspergillosis made by the IDSA in 2016
ELVIRA ALARCÓN-MANOJA, CELIA CARDOZO-ESPINOLA, PEDRO PUERTA-ALCALDE, CAROLINA GARCÍA-VIDAL

We sought to review the most important updates in the treatment of aspergillosis after the publication of the clinical practice guidelines for the diagnosis and management of invasive aspergillosis (IA) by the Infectious Diseases Society of America. Our aim is to discuss some of the key aspects concerning the following topics: early initiation of antifungal therapy, antifungal agent of choice, follow-up of patients with IA, and breakthrough aspergillosis.

Rev Esp Quimioter 2017; 30 (Suppl. 1): 26-29 [pdf]
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Rev Esp Quimioter 2017; 30 (Suppl. 1): 22-25

Invasive candidiasis in the neutropenic patient

JESÚS FORTÚN, FRANCESCA GIOIA

There are major differences in the epidemiology and prognosis of invasive candidiasis and candidemia in the neutropenic patient; however, a recent study performed in Spanish hospitals (Candipop) confirmed that mortality at 1 month is 30%, which is similar to that observed in the general population. Although Candida albicans is the most frequently isolated species, C. tropicalis, C. glabrata, and C. krusei are more prevalent than in non-neutropenic patients. The benefit of neutrophil transfusion is unclear, and catheter withdrawal must be tailored and based on confirmation of the diagnosis. Echinocandins are the first-line option for therapy and have a better safety profile than other agents.

Rev Esp Quimioter 2017; 30 (Suppl. 1): 22-25 [pdf]
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Rev Esp Quimioter 2017; 30 (Suppl. 1): 16-21

Update on the diagnosis of invasive fungal infection

ELISA IBÁÑEZ-MARTÍNEZ, ALBA RUIZ-GAITÁN, JAVIER PEMÁN-GARCÍA

The number of patients at risk of suffering invasive fungal infection (IFI) is increasing. Because of its high mortality, new rapid and accurate diagnostic tools are needed. Last advances in invasive candidiasis diagnosis comprise Peptide Nucleic Acid Fluorescent In-Situ Hybridization (PNA-FISH), direct MALDI-TOF or multiplex acid nucleic testing. While all of them rely in positive blood cultures, T2Candida© uses PCR coupled with T2Magnetic resonance detection directly in whole blood, allowing detection of 1-3 UFC/mL of Candida in about four hours. Beyond galactomannan (GM), novelties in IFI caused by molds include the international standardization of PCR techniques, with several commercial kits available. A combination of GM and PCR appears to be a good diagnostic strategy for invasive aspergillosis. PCR coupled to electrospray ionization/mass spectrometry and detection of volatile organic compounds in exhaled air by gas chromatography/mass spectrometry are other promising approaches to IFI diagnostic that still need to be validated.

Rev Esp Quimioter 2017; 30 (Suppl. 1): 16-21 [pdf]
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Rev Esp Quimioter 2017; 30 (Suppl. 1): 13-15

Highlights in HIV 2016
MARÍA JESÚS VIVANCOS, CRISTINA GÓMEZ-AYERBE, SANTIAGO MORENOResearch in HIV-infection continues to grow every year. Reports published in journals or presented at conferences in 2016-2017 have brought light to some issues that had been highly debated. We have selected three conceptual publications, which we find include important information for clinicians taking care of HIV-infected patients.Rev Esp Quimioter 2017; 30 (Suppl. 1): 13-15 [pdf]
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Rev Esp Quimioter 2017; 30 (Suppl. 1): 8-12

Epidemiology of antibiotic resistance in Pseudomonas aeruginosa. Implications for empiric and definitive therapy

PATRICIA RUIZ-GARBAJOSA, RAFAEL CANTÓN

Pseudomonas aeruginosa is one of the major pathogens causing hospital-acquired infections. It can easily develop antibiotic resistance through chromosomal mutations or by horizontal acquisition of resistant determinants. The increasing prevalence of multi-drug-resistant (MDR) or extensively-drug-resistant (XDR) P. aeruginosa isolates is associated with the dissemination of the so-called high-risk-clones, such as ST175. Infections caused by MDR/XDR are a cause of concern as they compromise the selection of appropriate empiric and definitive antimicrobial treatments. Introduction of new antibiotics with potent activity against MDR/XDR P. aeruginosa opens new horizons in the treatment of these infections.

Rev Esp Quimioter 2017; 30 (Suppl. 1): 8-12 [pdf]
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Rev Esp Quimioter 2017; 30 (Suppl. 1): 1-7

Update in Infectious Diseases 2017
FRANCISCO JAVIER CANDEL, MARINA PEÑUELAS, CLARA LEJÁRRAGA, TEODOR EMILOV, CARLA RICO, IRENE DÍAZ, CARLOS LÁZARO, JOSE MANUEL VIÑUELA-PRIETO, MAYRA MATESANZ

Antimicrobial resistance in complex models of continuous infection is a current issue. The update 2017 course addresses about microbiological, epidemiological and clinical aspects useful for a current approach to infectious disease. During the last year, nosocomial pneumonia approach guides, recommendations for management of yeast and filamentous fungal infections, review papers on the empirical approach to peritonitis and extensive guidelines on stewardship have been published. HIV infection is being treated before and more intensively. The implementation of molecular biology, spectrometry and inmunology to traditional techniques of staining and culture achieve a better and faster microbiological diagnosis. Finally, the infection is increasingly integrated, assessing non-antibiotic aspects in the treatment.

Rev Esp Quimioter 2017; 30 (Suppl. 1): 1-7 [pdf]
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Rev Esp Quimioter 2017; 30(3): 213-223

Consensus opinion on antifungal prophylaxis in haematologic patients: Results of the PROMIC project

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]

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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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Rev Esp Quimioter 2017, 30(4):280-284

A descriptive study of Hafnia alvei isolated from stool samples: an approach to its clinical assessment

MÓNICA DE FRUTOS, EVA LÓPEZ, ROSA ARAGÓN, LUIS LÓPEZ-URRUTIA, CARMEN RAMOS, MARTA DOMÍNGUEZ-GIL, LOURDES VIÑUELA, SONSOLES GARCINUÑO, JOSÉ MARÍA EIROS

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 forH. 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]

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