Rev Esp Quimioter 2017, 30(2):142-168

Consensus document on pneumococcal vaccination in adults at risk by age and underlying clinical conditions. 2017 Update                     

FERNANDO GONZÁLEZ-ROMO, JUAN JOSÉ PICAZO,  AMÓS GARCÍA ROJAS, MOISÉS LABRADOR HORRILLO, VIVENCIO BARRIOS, MARÍA CARMEN MAGRO, PEDRO GIL GREGORIO, RAFAEL DE LA CÁMARA, ALEJANDRO RODRÍGUEZ, JOSÉ BARBERÁN, FRANCISCO BOTÍA MARTÍNEZ, MANUEL LINARES RUFO, ISABEL JIMENO SANZ, JOSÉ MARÍA PORTOLÉS, FRANCISCO SANZ HERRERO,  JAVIER ESPINOSA ARRANZ, VALLE GARCÍA-SÁNCHEZ, MARÍA GALINDO IZQUIERDO, ENRIQUE MASCARÓS           

Invasive pneumococcal disease (IPD) and pneumococcal pneumonia (PP) represent an important health problem among aging adults and those with certain underlying pathologies and some diseases, especially immunosuppressed and some immunocompetent subjects, who are more susceptible to infections and present greater severity and worse evolution. Among the strategies to prevent IPD and PP, vaccination has its place, although vaccination coverage in this group is lower than desirable. Nowadays, there are 2 vaccines available for adults. Polysacharide vaccine (PPV23), used in patients aged 2 and older since decades ago, includes a greater number of serotypes (23), but it does not generate immune memory, antibody levels decrease with time, causes an immune tolerance phenomenon, and have no effect on nasopharyngeal colonization. PCV13 can be used from children 6 weeks of age to elderly and generates an immune response more powerful than PPV23 against most of the 13 serotypes included in it. In the year 2013 the 16 most directly related to groups of risk of presenting IPD publised a series of vaccine recommendations based on scientific evidence regarding anti-pneumococcal vaccination in adults with underlying pathologies and special conditions. A commitment was made about updating it if new scientific evidence became available. We present an exhaustive revised document focusing mainly in recommendation by age in which some more Scientific Societies have been involved.

Rev Esp Quimioter 2017; 30(2):142-168  [pdf]

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Rev Esp Quimioter 2015:28(1):21-28

Acceptability of the HPV vaccine among Spanish university students in the pre-vaccine era: a cross-sectional study                                 
 


PABLO CABALLERO-PÉREZ, JOSÉ TUELLS, JOSEBA REMENTERÍA, ANDREU NOLASCO, VICENTE NAVARRO-LÓPEZ, JAVIER ARÍSTEGUI              

Introduction. Cervical cancer (CC), the second most common cause of cancer deaths in women, is associated with the infection of human papillomavirus (HPV) and is more prevalent in women between the ages of 20 and 24. This research is aimed to determine the background about CC, the human papillomavirus infection and its vaccine, assessing its acceptability in university students.
Methods. Cross-sectional study over 1,750 students from the University of Alicante (2008) selected at random, proportional associated to gender and studies, by a validated ad-hoc questionnaire. Percentages were computed, confidence intervals, contingency tables according to sex, age and type of studies, calculating adjusted odd ratios (OR).
Results. A sample with 58.6 % of women and 6.6% of biohealth students was obtained. 87.3% were willing to have the vaccine to prevent human papillomavirus (HPV), 94.3% would give this vaccine to their daughters, and 48.0% had heard someone talk about the vaccine. 90.6% didn´t have a lot of knowledge about the HPV infection and 82.2% didn´t know much about the vaccine. 22.4% had knowledge of the association between HPV and CC. Women register higher OR in acknowledging the problem and are more receptive to having the vaccine. The HPV vaccine acceptability is associated to the sex, the confidence of vaccines as a preventive method; the influence of the background is low in relation to the vaccine predisposition.
Conclusions. A high acceptability of the vaccine was observed in the period of the study. Raising confidence in people about the vaccines can influence for a better predisposition to be vaccinated.

Rev Esp Quimioter 2015:28(1):21-28 [pdf]

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Rev Esp Quimioter 2015:28(3):157-159

New methodological advances: algorithm proposal for management of Clostridium difficile infection                                 
 


MARÍA JOSÉ GONZÁLEZ-ABAD,  MERCEDES ALONSO-SANZ              

 


Introduction. Clostridium difficile infection (CDI) is considered the most common cause of health care-associated diarrhea and also is an etiologic agent of community diarrhea. The aim of this study was to assess the potential benefit of a test that detects glutamate dehydrogenase (GDH) antigen and C. difficile toxin A/B, simultaneously, followed by detection of C. difficile toxin B (tcdB) gene by PCR as confirmatory assay on discrepant samples, and to propose an algorithm more efficient.
Material and Methods. From June 2012 to January 2013 at Hospital Infantil Universitario Niño Jesús, Madrid, the stool samples were studied for the simultaneous detection of GDH and toxin A/B, and also for detection of toxin A/B alone. When results between GDH and toxin A/B were discordant, a single sample for patient was selected for detection of C. difficile toxin B (tcdB) gene.
Results. A total of 116 samples (52 patients) were tested. Four were positive and 75 negative for toxigenic C. difficile (Toxin A/B, alone or combined with GDH). C. difficile was detected in the remaining 37 samples but not toxin A/B, regardless of the method used, except one. Twenty of the 37 specimens were further tested for C. difficile toxin B (tcdB) gene and 7 were positive.
Discussion. The simultaneous detection of GDH and toxin A/B combined with PCR recovered undiagnosed cases of CDI. In accordance with our data, we propose a two-step algorithm: detection of GDH and PCR (in samples GDH positive). This algorithm could provide a superior cost-benefit ratio in our population.

 

Rev Esp Quimioter 2015:28(3):157-159 [pdf]

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Rev Esp Quimioter 2015:28(Suppl. 1):34-37

Management of invasive candidiasis in non-neutropenic patient     

                        
 CELIA CARDOZO, JOSÉ MENSA              

Among the most frequents etiological agents that causing nosocomial infections, there is included Candida spp. Candida’s bloodstream infection mortality rates are over 30%. Antifungal early treatment is essential to improve the prognosis of this type of infection. Because of the lack of fast enough microbiological tests for early diagnosis, treatment must necessarily be initiated empirically.

Rev Esp Quimioter 2015:28(Suppl. 1):34-37 [pdf]

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Rev Esp Quimioter 2015:28(6):302-309

Use of antibiotics at a University Clinic Hospital: effect of protocolized antibiotic treatment in the evolution of hospital patients with infections     

                        
JOAQUÍN GÓMEZ-GÓMEZ, ELISA GARCÍA-VÁZQUEZ, CRISTINA BONILLO, ALICIA HERNÁNDEZ-TORRES, MANUEL CANTERAS-JORDANA              

Objectives. To analyse factors associated to “failure” in patients under antibiotic (AB) treatment at a third level hospital.
Patients and methods. All patients receiving an AB treatment along April 2012 were prospectively observed and factors associated to failure were analyzed. Failure was defined as clinical or microbiological failure, relapse or death. Statistically significance was established as p<0.05.
Results. 602 of 1,265 admitted patients during the study month included an AB in their medical prescriptions, being 178 considered as prophylactic AB prescriptions, 342 empirical treatments and 82 directed treatments as empiric treatments. Ceftriaxone and levofloxacin were the most used AB; choice of empirical and directed treatments were in line with protocols in 71% (242 of 342 cases) and 67% (55 of 82), respectively. Of all the patients receiving antibiotics for therapy (n=424), 402 had infection criteria (in 22 cases antibiotic treatment was deemed unnecessary since the patient showed no infectious process). Of these, 292 (72%) showed a good evolution, while the others were considered as failed therapies, either because of microbiological persistence in 49 (12.8%), relapse in 31 (7.71%) and death in en 30 (7.46%). Factors associated to “failure” were Charlson score ≥3 (OR 3.35; 95%CI 1.602-7.009); empirical and/or directed treatment not in keeping with the protocol (OR 5.68; 95%CI 2.898-11.217); and infection by ESBL and/or ciprofloxacin resistant E. coli (OR 4.43; 95%CI 1.492-13.184).
Conclusions. A high rate of AB prescriptions in admitted patients correspond to empirical infection treatment,  being ceftriaxone and levofloxacin the most used AB. Inadequate empirical and/or directed treatment is associated to clinical or microbiological failure and death.

Rev Esp Quimioter 2015;28(6):302-309 [pdf]

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Rev Esp Quimioter 2016, 29(3):113-118

Bacteriobilia: a non-resolved problem  

                    
CARLOS ARMIÑANZAS, LUIS ANTONIO HERRERA, MARÍA CARMEN FARIÑAS             

Bile duct is usually sterile, and the isolating of microorganisms (bacteriobilia) has been related to some factors, such as age, biliary drainage before pancreatic surgery or bile duct stones. Gramnegative strains remain the most frequent pathogens, especially Escherichia coli. Among grampositives Enterococcus spp should be mentioned.
Currently, there is controversy about whether the presence of bacteriobilia has an impact on unfavorable outcome of biliary disease or surgical procedures or mortality rates, with complications such as surgical site infections or bacteremia.
In high-risk patients, such as immunosuppressed or those underwent pancreaticoduodenectomy, bile duct cultures performed routinely, even if there are not clinical data of infection, could be necessary in order to start antibiotic treatment or to reduce its spectrum.

Rev Esp Quimioter 2016; 29(3):113-118 [pdf]

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Rev Esp Quimioter 2016, 29(5):249-254

Demographic characteristics, malaria chemoprophylaxis and vaccination in 6,783 international travelers attended in a specialized unit                     

NIEVES JAÉN-SÁNCHEZ, LAURA SUÁREZ-HORMIGA, CRISTINA CARRANZA-RODRÍGUEZ, MICHELE HERNÁNDEZ-CABRERA, ELENA PISOS-ÁLAMO, LOURDES GARCÍA-REINA, JOSÉ LUIS  PÉREZ-ARELLANO          

Background. The objective of this paper was to determine the demographic characteristics and the evolution of international travelers treated at the Unit of Infectious and Tropical Medicine in order to improve precautions prior to travel and, thus reduce the occurrence of these diseases.
Methods.  A retrospective study of all international travelers served in UEIMT (Las Palmas de Gran Canaria) during the period 1998-2013 was performed. The following variables were collected using a standardized protocol were analyzed: age, gender, date of consultation, type of traveler, countries of destination and preventive measures undertaken (malaria chemoprophylaxis and vaccines).
Results. A total of 6,783 international travelers of which 52% were women were analyzed. The average age was 36 years (SD 13). The most frequent destination continent was Africa (39%) followed by Asia (36%) and Latin America (23%). The most common country of destination was India 13% (882), followed by Senegal 7.5% (509) and Thailand 6.3% (429). The most frequently recommended vaccines were typhoid fever (82.9%) and hepatitis A (66.9%). As for malaria prophylaxis, the indicated drugs were atovaquone-proguanil (56.5%), mefloquine (36.7%), in regard to travelers returning to visit relatives and friends with a 26.81% were children (0-9 years).
Conclusions. The overall profile of the traveler is a young man who chooses holiday destination Africa followed by Asia and Latin America. Over 50% of travelers received vaccination against typhoid and hepatitis A. The most commonly used malaria chemoprophylaxis was atovaquone / proguanil followed by mefloquine.

Rev Esp Quimioter 2016; 29(5):249-254 [pdf]

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Rev Esp Quimioter 2016, 29(Suppl. 1):47-51

The role of antimicrobial stewardship programs in the control of bacterial resistance                     

JUAN PASQUAU, SVETLANA SADYRBAEVA, SAMANTHA E. DE JESÚS, CARMEN HIDALGO-TENORIO          

In order to improve infection prognosis and reduce the existing microbial resistance problem (a challenge similar to that of climate change), a higher implication of the Administration, an increased level of social awareness and the development of specific corporate networks, including the pharmaceutical industry, is needed. However, we must first consolidate Antimicrobial Stewardship Programmes with experts who seek to improve antibiotic therapy effectivity in severe infections and to reduce global antibiotic exposure.

Rev Esp Quimioter 2016; 29(Suppl. 1):47-51 [pdf]

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Rev Esp Quimioter 2017; 30(1):9-13

Time-to-positivity, type of culture media and oxidase test performed on positive blood culture vials to predict Pseudomonas aeruginosa in patients with Gram-negative bacilli bacteraemia                     

NAZARET COBOS-TRIGUEROS, YULIYA ZBOROMYRSKA, LAURA MORATA, IZASKUN ALEJO, CRISTINA DE LA CALLE, ANDREA VERGARA, CELIA CARDOZO, MARIA P. ARCAS, ALEX SORIANO, FRANCESC MARCO, JOSEP MENSA, MANEL ALMELA, JOSE A. MARTINEZ           

Introduction. The aim of this study was to determine the usefulness of oxidase test and time-to-positivity (TTP) in aerobic and anaerobic blood culture vials to detect the presence of Pseudomonas aeruginosa in patients with Gram-negative bacilli (GNB) bacteraemia.
Material and methods. TTP was recorded for each aerobic and anaerobic blood culture vial of monomicrobial bacteraemia due to GNB. Oxidase test was performed in a pellet of the centrifuged content of the positive blood culture. An algorithm was developed in order to perform the oxidase test efficiently taking into account TTP and type of vial.
Results. A total of 341 episodes of GNB bacteraemia were analysed. Sensitivity, specificity, positive predictive value and negative predictive value of the oxidase test performed on positive vials with GNB to predict P. aeruginosa were 95%, 99%, 91%, and 99%, respectively.  When growth was first or exclusively detected in anaerobic vials, P. aeruginosa was never identified hence the performance of the oxidase test could be avoided. When growth was only or first detected in aerobic vials, a TTP≥8h predicted P. aeruginosa in 37% or cases (63 of 169), therefore oxidase test is highly recommended.
Conclusions. Oxidase test performed onto positive blood culture vials previously selected by TTP and type of vials is an easy and inexpensive way to predict P. aeruginosa. In most cases, this can lead to optimization of treatment in less than 24 hours.

Rev Esp Quimioter 2017; 30(1):9-13  [pdf]

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Rev Esp Quimioter 2017, 30(2):96-102

Non-febrile syndromes in the traveler returning from tropical regions admitted in a monographic unit                     

ÁLVARO ANULA-MORALES, BÁRBARA MARTIN-GINER, MICHELE HERNÁNDEZ-CABRERA, CRISTINA CARRANZA-RODRÍGUEZ, ELENA PISOS-ÁLAMO, NIEVES JAÉN-SÁNCHEZ, JOSÉ-LUIS PÉREZ-ARELLANO           

 

Background. The aim was to analyse those syndromes without fever in travellers who return from tropical regions evaluated at our Department of Infectology and Tropical Medicine. Clarifying these conditions intends to reach earlier diagnoses and, perhaps, to avoid the emergence and spread of imported diseases, as well as to establish appropriate preventive measures. 
Methods. An observational descriptive transversal study was performed, selecting those patients who returned from tropical regions without fever (n = 281), amongst all travellers evaluated in our department between 1998 and 2013. We analysed demographic features, information related to the trip, as well as the presenting complaints and the diagnoses.
Results. A total of 281 international travellers presenting without fever were analysed. Only 39% had received health counsel prior to travelling. The most visited regions were Lat-in America (38.8%), Africa (37.8%) and Asia (13.6%). 15% of patients were asymptomatic or suffered from non-infectious conditions. Among the rest, most had either gastrointestinal (46%) or cutaneous (34%) syndromes. The main gastrointestinal condition was diarrhoea, with a microbiological diagnosis reached in almost 50% of cases. Regarding cutaneous syndromes, arthropods bites (31%) and different bacterial lesions (20%) were most common.
Conclusions. Approximately 10% of patients in Travel Medicine are international travellers returning from tropical regions, half of them with no fever. Most are diagnosed with infectious diseases, mainly gastrointestinal or cutaneous syn-dromes. Eosinophilia is the third problem in frequency among this group of patients, and sexually transmitted infections are rare in our cohort. It is important to emphasize in preventive activities.

Rev Esp Quimioter 2017; 30(2):96-102  [pdf]

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