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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(3):139-144

Role of double strand DNA break repair for quino-lone sensitivity in Escherichia coli: therapeutic implications                                 
 


ROCÍO GONZÁLEZ-SOLTERO, ANA GARCÍA-CAÑAS, ROSA B. MOHEDANO, BELÉN MENDOZA-CHAMIZO, EMILIA BOTELLO              

 

Introduction. Quinolones are one of the types of antibiotics with higher resistance rates in the last years. At molecular level, quinolones block  type II topoisomerases producing double strand breaks (DSBs). These DSBs could play a double role, as inductors of the  quinolone bactericidal effects but also as mediators of the resistance and tolerance mechanisms.
Material and methods. In this work we have studied the molecular pathways responsible for DSBs repair in the quinolone susceptibility: the stalled replication fork reversal (recombination-dependent) (RFR), the SOS response induction, the translesional DNA synthesis (TLS) and the nucleotide excision repair mechanisms (NER). For this reason, at the European University in Madrid, we analysed the minimal inhibitory concentration (MIC) to three different quinolones in Escherichia coli mutant strains coming from different type culture collections.
Results. recA, recBC, priA and lexA mutants showed a significant reduction on the MIC values for all quinolones tested. No significant changes were observed on mutant strains for TLS and NER.
Discussion. These data indicate that in the presence of quinolones, RFR mechanisms and the SOS response could be involved in the quinolone susceptibility.

Rev Esp Quimioter 2015:28(3):139-144 [pdf]

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Rev Esp Quimioter 2015:28(Suppl. 1):19-24

Inhaled medication and inhalation devices for lung disease     

                        
AMPARO SOLÉ, ROSA Mª GIRÓN              

Nebulized antibiotic therapy is an attractive therapeutic option given the high concentration obtained from the drug at the site of infection, minimizing the adverse effects and possible drug interactions. Inhalation of drugs as treatment of cystic fibrosis (CF) related lung disease has been proven to be highly effective. Consequently, an increasing number of drugs and devices have been developed for CF lung disease or are currently under development. Other limited areas of experience in this field are lung transplant recipients, immunosuppressed patients, bronchiectasis and ventilated patients. In this review document we analyse the current status of the inhaled medications, their modes of administration and indications and their results as well as side effects. Specifically we address antibiotics, and additionally, we review the current knowledge on devices for inhalation therapy with regard to optimal particle sizes and characteristics of wet nebulisers, dry powder and metered dose inhalers. Several factors contribute to a highly variable pulmonary drug deposition as the devices, the physical properties of the administered antimicrobial agent, the type of respiratory disease and the inhalation technique. Despite many clinicians have obtained a valuable experience from the aerosolized administration of antimicrobials and persuaded of their efficacy and safety. However, RCTs out of CF are needed to answer important clinical questions, such as what is the appropriate dose, the optimal delivery device, the optimal way of drug administration, as well as the exact therapeutic role and pharmacokinetic profile of aerosolized drug.

Rev Esp Quimioter 2015:28(Suppl. 1):19-24 [pdf]

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Rev Esp Quimioter 2015:28(6):282-288

Potential antimicrobial drug interactions in clinical practice: consequences of polypharmacy and multidrug resistance     

                        
CRISTINA MARTÍNEZ-MÚGICA              

Background. Polypharmacy is a growing problem nowadays, which can increase the risk of potential drug interactions, and result in a loss of effectiveness. This is particularly relevant to the antiinfective therapy, especially when infection is produced by resistant bacteria, because therapeutic options are limited and interactions can cause treatment failure.
Methods. All antimicrobial prescriptions were retrospectively reviewed during a week in the Pharmacy Department, in order to detect potential drug-interactions and analysing their clinical significance. A total of 314 antimicrobial prescriptions from 151 patients were checked.
Results. There was at least one potential interaction detected in 40% of patients, being more frequent and severe in those infected with multidrug-resistant microorganisms. Drugs most commonly involved were quinolones, azoles, linezolid and vancomycin.
Conclusions. Potential drug interactions with antimicrobial agents are a frequent problem that can result in a loss of effectiveness. This is why they should be detected and avoided when possible, in order to optimize antimicrobial therapy, especially in case of multidrug resistant infections.

Rev Esp Quimioter 2015;28(6):282-288 [pdf]

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Rev Esp Quimioter 2016, 29(2):86-90

Surveillance of antimicrobial susceptibility of Escherichia coli producing urinary tract infections in Galicia (Spain)     

                        

MERCEDES TREVIÑO, ISABEL LOSADA, BEGOÑA FERNÁNDEZ-PÉREZ, AMPARO COIRA, MARÍA F. PEÑA-RODRÍGUEZ, XURXO HERVADA Y GRUPO DE ESTUDIO DE LA SOGAMIC PARA EL ESTUDIO DE RESISTENCIAS EN GALICIA             


Introduction. Escherichia coli is the microorganism responsible for most of the community-acquired urinary tract infections (UTI). Our purpose was to determine the susceptibility of E. coli associated with UTI in Galicia and consider the most appropriate antibiotics for empirical treatment.
Methods. Retrospective study during the period 2011- 2012 of the isolation of E. coli in urine samples from almost all the Galician population. Demographic variables, minimum inhibitory concentration, and reading data were collected: amoxicillin-clavulanate, cefotaxime, gentamicin, amikacin, ciprofloxacin, cotrimoxazole, nitrofurantoin and fosfomycin. The identification and susceptibility studies were mainly conducted by automated systems. The interpretation of the results was performed according to CLSI criteria.
Results. During the study period 55,046 E. coli were isolated in UTI. The percentages of resistance were: cotrimoxazole, 30%; ciprofloxacin, 33%; amoxicillin-clavulanate, 23% and 10% for 3rd generation cephalosporins. Fosfomycin and nitrofurantoin showed the highest activity with more than 96% of susceptibility in our study. The linear trend of resistance regarding age was statistically significant (p <0.0001) as it was regarding males (p <0.00001) for all antibiotics.
Conclusions. In Galicia, the most active antibiotics against E. coli associated with UTI are fosfomycin and nitrofurantoin so they should be considered as empirical treatment of choice by the community-acquired UTI not complicated by E. coli.

Rev Esp Quimioter 2016; 29(2):86-90 [pdf]

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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.

Rev Esp Quimioter 2016; 29(6):318-327 [pdf]

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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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