,

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]

/por
,

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]

/por

Rev Esp Quimioter 2015:28(3):116-124

Hydatidosis: epidemiological, clinical, diagnostic and therapeutic aspects                                 
 


CARLOS ARMIÑANZAS, MANUEL GUTIÉRREZ-CUADRA, MARÍA CARMEN FARIÑAS              

Hydatidosis or cystic echinococcosis (CE) is a parasitic zoonosis caused by Echinococcus granulosus. Its life cycle involves dogs, sheep and sometimes other animals. CE has a worldwide distribution, with greater prevalence in temperate zones. In Spain, Castile and León, La Rioja, Navarre, Aragón, and the Mediterranean coast are the areas where it is most commonly diagnosed, although there have also been published cases in other regions, such as Cantabria. Clinical signs and symptoms of EC may be related to the mass effect of the cyst, its superinfection or anaphylactic reactions secondary to its rupture. Because of its slow growth, diagnosis is usually made in adulthood by combining clinical symptoms with imaging and serological tests. There is no universal consensus on the management of CE. Treatment is based mainly on three pillars: medical treatment (mainly albendazole), surgery, and percutaneous drainage. The choice of the most appropriate approach is based on the patient’s symptoms and the characteristics of the cysts.

Rev Esp Quimioter 2015:28(3):116-124 [pdf]

/por

Rev Esp Quimioter 2015:28(Suppl. 1):8-11

Laboratory detection of carbapenemase-producing Enterobacteriaceae     

                        
EMILIA CERCENADO              

Detection of carbapenemase-producing Enterobacteriaceae in the laboratory requires an exhaustive analysis of the antibiogram and susceptibility to all beta-lactams, the implementation with phenotypic methods of screening as well as confirmatory procedures including the detection of the carbapenem hydrolysis, the inhibition of the enzyme activity with several specific inhibitor compounds and by molecular methods.

Rev Esp Quimioter 2015:28(Suppl. 1):8-11 [pdf]

/por

Rev Esp Quimioter 2015:28(5):256-262

Bacteraemia due to extended-spectrum beta-lactamases (ESBL) and other beta-lactamases (ampC and carbapenemase) producing Enterobacteriaceae: association with health-care and cancer)     

                        
MIRIAM GARCÍA-GÓMEZ, LAURA GUÍO, JOSÉ LUIS HERNÁNDEZ, BEGOÑA VILAR, JOSÉ IGNACIO PIJOÁN, JOSÉ MIGUEL MONTEJO              

Introduction. Bloodstream infections due to multire-sistant Enterobacteriaceae are a major matter of concern nowadays. The present study evaluated the impact of these infections in our area.
Methods. Prospective observational study of a cohort of patients with bacteraemia due to extended-spectrum beta-lactamases (ESBL) and other beta-lactamases producing organisms among hospitalized patients in Cruces Hospital for 2 years. We conducted a descriptive analysis, a subgroup analysis (cancer vs. non-cancer patients) and a mortality analysis.
Results. During the study period, 3409 episodes of bacteraemia were diagnosed, of which 124 (3.6%) were ESBL and other beta-lactamases producing Enterobacteriaceae. 40.3% of the cases were nosocomial, 15.3% community acquired and 44.4% were health-care associated. 44.4% of the cohort had cancer as underlying disease. The most commonly isolated organism was E. coli (83% of cases), regardless of the source of infection. 58.1% of patients received inadequate empirical therapy. 7 day-mortality was 10.5% and 30 day-mortality was 21.8%. None of the analyzed variables showed association with 7 and 14 day-mortality, but the presence of solid cancer (p= 0.032) and advanced HIV infection (p = 0.027), were significantly associated with higher 30 day-mortality.
Conclusions. More than half of bacteraemia episodes affected outpatients and most of them were health-care associated episodes. Even though more than half of the patients received inadequate empirical treatment, this was not related to higher mortality. We only found an association between 30 day-mortality and the presence of underlying solid malignancy or advanced HIV infection.

Rev Esp Quimioter 2015:28(5):256-262 [pdf]

/por

Rev Esp Quimioter 2016, 29(2):69-75

A comparison of the efficacy of piperacillin-tazobactam and cefoperazone-sulbactam therapies in the empirical treatment of patients with febrile neutropenia     

                        

AYNUR AYNIOGLU, BIRSEN MUTLU, ABDULLAH HACIHANEFIOGLU             

  

Introduction. Empirical antibiotic therapy in neutropenic patients presenting with fever plays a significant role in reducing mortality related to infection. Empirical therapies with broad-spectrum intravenous bactericidal, anti-pseudomonal antibiotics are accepted treatments for febrile neutropenic patients. The aim of this study was to compare the efficacy of piperacillin-tazobactam (PIP-TAZO) and cefoperozone-sulbactam (CS) therapies in adult patients with haematological malignancies presenting with neutropenic fever in a prospective study design.
Methodology. Patients with haematological malignancies (leukaemia, lymphoma, multiple myeloma, and myelodysplastic syndrome) were recruited from June 2010–May 2013.  Participants were over 18 years old, with an absolute neutrophil count (ANC) of less than 500/mm³ following chemotherapy or expected to have an ANC less than 500/mm³ in the first 48 h post-chemotherapy, and with an oral body temperature ≥ 38.3°C at a single measurement or 38.0°C after 1-h monitoring. Patients were randomised to the two treatment groups. The initial empirical therapy comprised PIP-TAZO (4.5 g/6 h/day, IV) and CS (2 g/8 h/day, IV).
Results. The overall success rate was 61% with CS and 49% with PIP-TAZO (p =0.247). Factors affecting the treatment success included a neutrophil count <100/mm3, being in the relapse/refractory stage of malignancy, and the presence of a microbiologically documented infection (p <0.05).
Conclusion. PIP-TAZO and CS monotherapies are equally effective and safe for the empirical treatment of febrile neutropenic patients.

Rev Esp Quimioter 2016; 29(2):69-75 [pdf]

/por

Rev Esp Quimioter 2016, 29(4):220-223

Development of a PCR for the detection and quantification of parasitism by Demodex folliculorum infestation in biopsies of skin neoplasms periocular area                     

ALBERTO TENORIO-ABREU, JUAN CARLOS SÁNCHEZ-ESPAÑA, LIGIA ESPERANZA NARANJO-GONZÁLEZ, MARÍA CARMEN GONZÁLEZ-GALLEGO, CARLOS HIDALGO-GRASS, CARLOS RUÍZ-FRUTOS          

Objective. To standardize the relative quantification by mass of tissue parasitism by Demodex folliculorum infestation from neoplastic skin biopsies periocular using molecular amplification to study the possible relationship of the appearance of eyelid basal cell carcinoma with the presence and density of the mite in later works.
Methods. A quantitative PCR was developed real-time probes TaqMan. PCR was tested in a pilot 46 actual biopsy samples nodular basal cell carcinoma series.
Results. The sensitivity was placed with a detection limit of between 1 and 10 copies / μl. 50% (23/46) of the biopsies were positive for D. folliculorum. The specificity was 100% confirmed by sequencing.
Conclusion. The technique shows good results for sensitivity and specificity that can make it useful as a tool for studies of cause and effect D. folliculorum and basal cell carcinoma.

Rev Esp Quimioter 2016; 29(4):220-223 [pdf]

/por

Rev Esp Quimioter 2016, 29(Suppl. 1):21-25

Epidemiology of multi-drug resistant gramnegative bacilli                     

PATRICIA RUIZ-GARBAJOSA, RAFAEL CANTÓN          

Current antimicrobial resistance in Gram negative bacilli is particularly worrisome due to development of resistance to all available antimicrobial agents. This situation dramatically limits therapeutic options. The microorganisms acquire a multiresistance phenotype as a consequence of different complex processes in which the antimicrobials acts as selective driver of resistance. Dissemination of multiresistant bacteria is driven by the expansion of the high-risk clones. These clones can be selected in the presence of antimicrobials allowing their persistence over time.

Rev Esp Quimioter 2016; 29(Suppl. 1):21-25 [pdf]

/por

Rev Esp Quimioter 2016, 29(6):296-301

Seasonal influenza in octogenarians and nonagenarians admitted to a general hospital: epidemiology, clinical presentation and prognostic factors                     

JOSÉ M. RAMOS, M. MAR GARCÍA-NAVARRO, M. PILAR GONZÁLEZ DE LA ALEJA, ROSARIO SÁNCHEZ-MARTÍNEZ, ADELINA GIMENO-GASCÓN, SERGIO REUS, ESPERANZA MERINO, JUAN C. RODRÍGUEZ-DÍAZ JOAQUÍN PORTILLA          

Background. Seasonal influenza is responsible for high annual morbidity and mortality worldwide, especially in elderly patients. The aim of the study was to analyse the epidemiological, clinical and prognostic features of influenza in octogenarians and nonagenarians admitted to a general hospital, as well as risk factors associated with mortality.
Methods. Retrospective, cross-sectional, descriptive study in patients admitted and diagnosed with influenza by molecular biology in the General University Hospital of Alicante from 1 January to 31 April 2015.
Results. A total of 219 patients were diagnosed with influenza in the study period: 55 (25.1%) were ≤64 years-old; 77 (35.2%) were aged 65–79; 67 (30.6%) were aged 80–89 years; and 20 (9.1%) were aged ≥90 years. Most flu episodes were caused by influenza A (n=181, 82.6%). Patients aged 80 years or older had lower glomerular filtration rate (mean: 49.7 mL/min vs. 62.2 mL/min; p=0.006), a greater need for non-invasive mechanical ventilation (22% vs 9.3%; p=0.02), greater co-morbidity due to cardiac insufficiency (40.5% vs. 16.4%; p<0.001) and chronic renal disease (32.9 vs. 20%, p=0.03), and greater mortality (19% vs. 2.9%; p<0.001). In a multivariate analysis, mortality was higher in those aged 80 or over (adjusted odds ratio [ORa] 9.2, 95% confidence interval [CI] 1.65–51.1), those who had acquired the flu in a long-term care facility (ORa 11.9, 95% CI 1.06–134), and those with hyperlactataemia (ORa 1.89, 95% CI 1.20–3.00).
Conclusions. Seasonal influenza is a serious problem leading to elevated mortality in octogenarian and nonagenarian patients admitted to a general hospital.

Rev Esp Quimioter 2016; 29(6):296-301  [pdf]

/por

Rev Esp Quimioter 2017, 30(2):127-130

Fluconazole-containing agar Sabouraud dextrose plates are not useful when screening for susceptibility in Candida albicans                     

MARÍA ÁNGELES BORDALLO-CARDONA, LAURA JUDITH MARCOS-ZAMBRANO, ELIA GÓMEZ G. DE LA PEDROSA, PILAR ESCRIBANO, EMILIO BOUZA, JESÚS GUINEA, RAFAEL CANTÓN           

Introduction. Fluconazole is an alternative for candidemic patients who are not critically ill. Fluconazole is mainly fungistatic and does not completely inhibit visual Candida albicans growth. We studied the usefulness of fluconazole-containing Sabouraud dextrose agar plates for detecting susceptibility to fluconazole in C. albicans.
Material and methods. Adjusted inocula of 19 isolates were transferred directly onto fluconazole-containing Sabouraud dextrose plates (concentrations ranging from 0.125 mg/L to 128 mg/L). The fluconazole MIC in fresh isolates and after growth on the fluconazole-containing plate at 128 mg/L was recorded following the EUCAST EDef 7.2 guidelines. Then isolates were classified according to their degree of trailing production, based on microdilution procedure.
Results. All isolates were able to grow on all fluconazole-containing plates, even those isolates susceptible to fluconazole. In fact, we selected isolates with different degrees of trailing based on microdilution procedures. 50% of isolates classified as heavy trailers, 35.71% as moderate trailers, and 14.28% as slight trailers.
Conclusions. The use of fluconazole-containing Sabouraud dextrose agar plates was not a reliable method to detect fluconazole susceptibility in C. albicans isolates; growth of the isolates was a trailing effect rather than true resistance.

Rev Esp Quimioter 2017; 30(2):127-130  [pdf]

/por