Rev Esp Quimioter 2017, 30(5): 327-333

Infectious complications related to external ventricular shunt. Incidence and risk factors

LUCÍA LÓPEZ-AMOR, LUCÍA VIÑA, LORENA MARTÍN, CLEMENTINA CALLEJA, RAQUEL RODRÍGUEZ-GARCÍA, IVÁN ASTOLA, LORENA FORCELLEDO, LAURA ÁLVAREZ-GARCÍA, CARMEN DÍAZ-GÓMEZ, JAVIER FERNÁNDEZ-DOMÍNGUEZ, FERNANDO VÁZQUEZ, DOLORES ESCUDERO, GRUPO DE INVESTIGACIÓN EN MICROBIOLOGÍA TRASLACIONAL DEL INSTITUTO DE INVESTIGACIÓN SANITARIA DEL PRINCIPADO DE ASTURIAS (ISPA)

Introduction.  Infectious complications related to external ventricular shunt (ICREVS) are a main problem in neurocritical intensive care units (ICU). The aim of the review is to assess the incidence of ICREVS and to analyse factors involved.
Material and methods.  Retrospective analysis, adult polyvalent ICU in a third level reference hospital. Patients carrying external ventricular shunt (DVE) were included. Those patients with central nervous system infection diagnosed prior DVE placement were excluded.
Results. 87 patients were included with 106 DVE. Most common admittance diagnosis was subarachnoid haemorrhage (49.4%). 31 patients with 32 DVE developed an ICREVS. Infection rate is 19.5 per 1000 days of shunt for ICREVS and 14 per 1000 days for ventriculitis. 31.6% of the patients developed ICREVS and 25.3% ventriculitis. Patients who developed ICREVS presented higher shunt manipulations (2.0 ± 0.6 vs. 3.26 ± 1.02, p=0.02), shunt repositioning (0.1 ± 0.1 vs. 0.2 ± 0.1) and ICU and hospital stay (29.8 ± 4.9 vs 49.8 ± 5.2, p<0.01 y 67.4 ± 18.8 vs. 108.9 ± 30.2, p=0.02. Those DVE with ICREVS were placed for longer not only at infection diagnosis but also at removal (12.6 ± 2.1 vs. 18.3 ± 3.6 and 12.6 ± 2.1 vs. 30.4 ± 7.3 days, p<0.01). No difference in mortality was found.
Conclusions. One out of three patients with a DVE develops an infection. The risk factors are the number of manipulations, repositioning and the permanency days. Patients with ICREVS had a longer ICU and hospital average stay without an increase in mortality.

Rev Esp Quimioter 2017; 30(5): 327-333 [pdf]

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Rev Esp Quimioter 2017, 30(5): 334-340

Gastrostomy tubes: indications and infectious complications in a tertiary hospital

MARÍA JOSÉ MUÑOZ-DÁVILA, JOSÉ MARÍA XANDRI GRAUPERA, GENOVEVA YAGÜE GUIRAO, CARME SALVADOR GARCÍA, MANUEL SEGOVIA HERNÁNDEZ

Introduction. Gastrostomy tube is the best option for long-term enteral nutrition. Among its limitations, infections represent the most frequent minor complication. Our aim is the knowledge of the number and type of gastrostomy tubes and its main indication in our hospital. In addition, prevalence of infectious complications was studied paying attention to the main etiologic agents and their antibiotic susceptibility.
Methods. Observational retrospective study from January 2010 to July 2015 through the electronic clinical history and the clinical microbiology laboratory software. Identification and antibiotic susceptibility of clinically significant isolates from patients with suspicion of gastrostomy tube infection have been analysed.
Results. Percutaneous endoscopic gastrostomy was performed in 203 patients (70.5%) and surgical gastrostomy in 85 (29.5%). The main reason identified for starting enteral nutrition through gastrostomy tube was malignant neoplasy, above all, lip, oral cavity and pharynx cancer (11.8%) and that from digestive organs (8.7%). Global prevalence of gastrostomy tube infection was 16.6%. The most common bacterial pathogens isolated wereStaphylococcus aureus (21.3%), Pseudomonas aeruginosa (13.1%), and Escherichia coli (9.8%). The percentage of multi resistant isolates was 3.1%.
Conclusions. Gastrostomy tube indications and type, and also, prevalence and microorganisms isolated from culture in infectious complications are similar to those described previously in the literature. The study allows the adaptation of the antibiotic prophylaxis and empirical antibiotic treatment thanks to the knowledge of the etiologic agents and their antibioticsusceptibility.

Rev Esp Quimioter 2017; 30(5): 334-340 [Texto completo – PDF]

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Rev Esp Quimioter 2017, 30(5): 368-371

Importance of the forensic autopsy in the diagnosis of septic shock: a case report

AGUSTÍN SIBÓN-OLANO, ENCARNACIÓN SÁNCHEZ-RODRÍGUEZ, MÓNICA PAYÁ, ESTEFANÍA BARRERA-PÉREZ, MANUEL SALGUERO-VILLADIEGO, AMPARO FERNÁNDEZ-RODRÍGUEZ

Septic shock sometimes starts with unspecific symptoms that hamper the clinical diagnosis and, therefore an appropriate treatment. When the septic shock follows a fulminating course with a fatal outcome, the etiological diagnosis has to be conducted post-mortem. Sudden unexpected deaths in children and young adults are frequently the object of medico-legal autopsies. Some sudden unexpected deaths have an infectious origin, which requires further analyses, including microbiology, to establish the cause of death. Here, the case of a fatal septic shock in a 19-month old male infant is presented. After a mild foot injury, an infection by Streptococcus pyogenes progressed to septic shock with a fatal outcome as post-mortem studies demonstrated.

Rev Esp Quimioter 2017; 30(5): 368-371 [Texto completo – PDF]

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Rev Esp Quimioter 2017, Apr 25

Carbapenem resistance in Pseudomonas aeruginosa isolated from urine cultures: prevalence and risk factors

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; Apr 25 [pdf]

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Rev Esp Quimioter 2017, May 10

Prevalence of human papillomavirus in Spanish women from a population screening program

SARA GARCIA, MARTA DOMINGUEZ-GIL, JORGE GAYETE, SILVIA ROJO, JUAN LUIS MUÑOZ, JOSÉ SANTOS SALAS, CELINA ECHEVARRIA, MANUEL BLANCO, CARMEN RAMOS, MÓNICA DE FRUTOS, LUIS LÓPEZ-URRUTIA, LOURDES VIÑUELA, SONIA TAMAMES, PEDRO REDONDO, JOSÉ MARÍA JIMÉNEZ, JOSÉ MARÍA EIROS, RAÚL ORTIZ DE LEJARAZU

Introduction. The human papillomavirus (HPV), is necessary to cause a woman developing cervical cancer. The aim of the study was to estimate the prevalence of women with HPV infection, covered by the program of prevention and early detection of cervical cancer of Castile and León (Spain).
Material and methods. Samples of women included in the screening program were analyzed. Including a total of 120,326 cervical swab samples, collected in the period from January 2012 to December 2014.
Results. 12,183 HPV positive samples were detected, representing a prevalence of 9.6 ‰, (IC 95% 9.5%-9.8%) in the female population. High-risk HPV were found in higher proportion that HPV low-risk genotypes. HPV prevalence correlates inversely with women age. Coinfections of multiple genotypes were found in one third of screened women population.
Conclusions. Data showed in this study are the first and wider Spanish results from a cervical cancer screening program population non opportunistic based on HPV detection. These results would serve as a reference for future prevalence studies and to evaluate the future impact of HPV vaccination campaigns.

Rev Esp Quimioter 2017; May 10 [pdf]

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Rev Esp Quimioter 2015:28(2):79-85

An analysis of the association between genotype and antimicrobial resistance in methicillin-resistant Staphylococcus aureus clinical isolates                                 
 


VICENTE AGUADERO, CARMEN GONZÁLEZ-VELASCO, ANA VINDEL, MIGUEL GONZÁLEZ-VELASCO, JUAN JOSÉ MORENO              

 

Genotyping methods are useful resources for the surveillance, detection, prevention and control of multidrug-resistant nosocomial agents, such as methicillin-resistant Staphylococcus aureus (MRSA). An understanding of the association between genotype and antibiotic susceptibility in MRSA clones may be useful in the surveillance of MRSA and to avoid inappropriate treatment future resistance. We genotyped MRSA clinical isolates from the Extremadura region of Spain using pulsed field electrophoresis (PFGE) and analyzed the spectrum of antibiotic susceptibility for each isolate to determine whether resistance is associated with specific genotypes. PFGE revealed six major genotypes: E8a (25%), E7b (17%), E7a (12%), E8B (8%), E10 (6%), and E20 (4%). Isolates with the genotypes E8a and E10 exhibit higher resistance ratios for levofloxacin than isolates with the other major pulsotypes. Similar results were obtained for isolates with the E20 pulsotype with respect to mupirocin. Although we identified no vancomycin-, tigecycline-, linezolid- or daptomycin-resistant strains, we observed significant differences in the mean MIC values obtained for some of these drugs among the major genotypes. Specifically, isolates with the E7b, E8b, and E20 genotypes have signif-icantly higher MICs of tigecycline, vancomycin and linezolid, respectively, than the most sensitive pulsotypes. Isolates with the E8b profile also exhibit a significantly higher rate of re-duced vancomycin susceptibility (RVS) (i.e., MIC between 1 and 2 mg/L) than clones with the E10 and E8a profiles. In conclusion, we report associations between genotype and antibiotic sensitivity that should be considered in programs for monitor-ing and controlling MRSA in health care settings.

Rev Esp Quimioter 2015:28(2):79-85 [pdf]

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Rev Esp Quimioter 2015:28(4):207-209

Characterization of daptomycin non-susceptible Enterococcus faecium producing urinary tract infection in a renal transplant recipient      

                          

ANTONIO SORLÓZANO, DIANA PANESSO, JOSÉ MARÍA NAVARRO-MARÍ, CESAR A ARIAS, JOSÉ GUTIÉRREZ-FERNÁNDEZ              

Objectives. Characterization of a urine isolate of daptomycin non-susceptible Enterococcus faecium recovered from a patient with kidney transplantation and no history of daptomycin exposure.
Methods. After isolation in a urine sample, identification of E. faecium was confirmed by amplification of the E. faecium-specific gene encoding D-alanyl-D-alanine ligase (ddl) and daptomycin susceptibility testing was performed by E-test on cation-adjusted Mueller-Hinton agar. In order to determine the genetic bases of daptomycin resistance, the open reading frames of five genes previously associated with daptomycin resistance in enterococci were sequenced.
Results. Substitutions in the response regulator LiaR (S19F) and cardiolipin synthase (R218Q) were identified.
Conclusions. To the best of our knowledge, this is the first characterization of emerging daptomycin resistance in E. faecium in a Spanish hospital in the absence of daptomycin exposure and in a renal transplant recipient.

Rev Esp Quimioter 2015:28(4):207-209 [pdf]

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Rev Esp Quimioter 2015:28(Suppl. 1):54-56

Is it possible to cure HIV infection?     

                        
 CAROLINA GUTIÉRREZ, NADIA P. MADRID, SANTIAGO MORENO              

Antiretroviral therapy has significantly improved the life expectancy in HIV-infected people, but it cannot cure the disease by itself. Several barriers have been identified for the cure of HIV infection, including a reservoir of latently infected cells, persistent viral replication in tissues, and anatomical sanctuaries. The main strategy proposed for the cure of HIV consists on the administration of drugs that, through the reactivation of latent HIV, would eliminate the cell reservoir. Ongoing clinical trials have shown the proof of concept, but the efficacy of these drugs in decreasing the reservoir size has not been proved so far.

Rev Esp Quimioter 2015:28(Suppl. 1):54-56 [pdf]

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Rev Esp Quimioter 2016;29(1):1-7

Current status of drug treatment against the disease caused by the Ebola virus     

                        
JORDI REINA              

The recent epidemic of disease caused by the Ebola virus has highlighted the need to develop specific drugs and have to deal with this entity. According to virological analysis they have been designed to give you some new drugs and are proven to others might be effective against this virus.
The main lines of therapy are based on immunotherapy (convalescent serum of patients and specific monoclonal an-tibodies), antiviral drugs (favipiravir, BCX4430, brincidofovir), interfering RNAs (TKM-Ebola) and antisense oligonucleotides (morpholino phosphorodiamidate) and other drugs no antiviral (clomiphene NSC62914, FGI-103, amiloride and ouabain).
Existing studies are scarce and mainly in animal models and clinical trials have been inconclusive most by the drastic reduction in the number of new cases.
However, progress has been made in the biological knowl-edge of Ebola virus and have been located new therapeutic tar-gets for the future development of specific antiviral.

Rev Esp Quimioter 2016;29(1):1-7 [pdf]

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Rev Esp Quimioter 2016, 29(3):119-122

An antimicrobial stewardship program reduces antimicrobial therapy duration and hospital stay in surgical wards   

                    
ROBERT GÜERRI-FERNÁNDEZ, JUDIT VILLAR-GARCÍA, SABINA HERRERA-FERNÁNDEZ, MARTA TRENCHS-RODRÍGUEZ, JORDI FERNÁNDEZ-MORATO, LUCÍA MORO, JOAN SANCHO, LUIS GRANDE, ALBERT CLARÁ, SANTIAGO GRAU, JUAN PABLO HORCAJADA             

An antimicrobial stewardship program reduces antimicrobial therapy duration and hospital stay in surgical wardsWe report a quasi-experimental study of the implementation of an antimicrobial stewardship program in two surgical wards, with a pre-intervention period with just assessment of prescription and an intervention period with a prospective audit on antibiotic prescription model. There was a significant reduction of length of stay and the total days of antimicrobial administration. There were no differences in mortality between groups. The antimicrobial stewardship program led to the early detection of inappropriate empirical antibiotic treatment and was associated with a significant reduction in length of stay and the total duration of antimicrobial therapy.

Rev Esp Quimioter 2016; 29(3):119-122 [pdf]

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