Rev Esp Quimioter 2016, 29(4):195-201

Adequacy of treatment with ertapenem according to the criterion approved for the infection´s commission of a specialty hospital                     

MERCEDES MANZANO-GARCÍA, ESTHER MÁRQUEZ-SAAVEDRA             

Introduction. The inappropriate use of antibiotics in our environment increases the risk of multi-resistant bacteria, therefore it is necessary to present studies to meet and promote the proper use of antimicrobial.
Methods. Retrospective observational study in which patients who are receiving ertapenem during the period of stady (5 ½ months), were included. The adequacy of the indication to the conditions of use agreed in the Hospital was evaluated and the evolution of the treatment was monitored until the end, determining the degree of therapeutic de-escalation.
Results. 84 ertapenem prescriptions were included. The vast mayority of the prescriptions were carried out by Internal Medicine (41.7%) and the main indication was urinary tract infection (47.2%). Microbiological cultures were requested in the 75% of the patients before the first dose of ertapenem. The prescription was adapted in 69 (82.14%) of ertapenem patients to the criteria approved by the Hospital. Regarding the evolution of antibiotic therapy, treatment with ertapenem continued until resolution of the infection in 58.33% of patients. In 15 of 23 (66.21%) patients with the possibility of therapeutic de-escalation it was performed after 2-3 days of empirical treatment.
Conclusions. The vast majority of treatments ertapenem fit the criteria of prescription our Hospital. The high percentage of patients with microbiological results available, allowed in many patients the appropriate adjustment of the treatment in the first 72 hours.

Rev Esp Quimioter 2016; 29(4):195-201 [pdf]

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Rev Esp Quimioter 2016, 29(Suppl. 1):15-20

Directed therapeutic approach to Staphylococcus aureus infections. Clinical aspects of prescription                     

FRANCISCO CARMONA-TORRE, MARTA RUA, JOSÉ LUIS DEL POZO          

 

Infections caused by Staphylococcus aureus have had classically an important impact in morbidity and mortality in the nosocomial and community scene. The description of methicillin resistance among nosocomial isolates of S. aureus and his widespread diffusion has become methicillin-resistant S. aureus (MRSA) in one of the most common causes of bacterial nosocomial infections. In the last years MRSA strains have also emergence in the community. This together with a progressive increase in resistance to antibiotics used classically has become vancomycin in the treatment of choice in most cases according to clinical guidelines.
As a result, a progressive rise in the minimum inhibitory concentration (MIC) to vancomycin has been reported. In this context strains with intermediate susceptibility to vancomycin (MIC 8-4 mg/L) and heteroresistance have been noted. These strains are associated with a higher risk of treatment failure when using vancomycin.
Among isolates of S. aureus susceptible to vancomycin there has been described stains with elevated MICs (≥1.5 mg/L). It is controversial if the presence of these strains has an impact on clinical outcome if treatment with vancomycin or β-lactams is prescribed.
The development of new antibiotics with activity against MRSA and exploring synergies offer a promising alternative to treatment with vancomycin.

Rev Esp Quimioter 2016; 29(Suppl. 1):15-20 [pdf]

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Rev Esp Quimioter 2016, 29(6):332-335

Multilocus Sequence Typing analysis of human Campylobacter coli in Granada (Spain)                     

JOSÉ ANTONIO CARRILLO-ÁVILA, ANTONIO SORLÓZANO-PUERTO, MERCEDES PÉREZ-RUIZ, JOSÉ GUTIÉRREZ-FERNÁNDEZ          

Introduction. Different subtypes of Campylobacter spp. have been associated with diarrhoea and a Multilocus Sequence Typing (MLST) method has been performed for subtyping. In the present work, MLST was used to analyse the genetic diversity of eight strains of Campylobacter coli.
Material and methods. Nineteen genetic markers were amplified for MLST analysis: AnsB, DmsA, ggt, Cj1585c, CJJ81176-1367/1371, Tlp7, cj1321-cj1326, fucP, cj0178, cj0755/cfrA, ceuE, pldA, cstII, cstIII. After comparing the obtained sequences with the Campylobacter MLST database, the allele numbers, sequence types (STs) and clonal complexes (CCs) were assigned.
Results. The 8 C. coli isolates yielded 4 different STs belonging to 2 CCs. Seven isolates belong to ST-828 clonal complex and only one isolate belong to ST-21. Two samples came from the same patient, but were isolated in two different periods of time.
Conclusions. MLST can be useful for taxonomic characterization of C. coli isolates.

Rev Esp Quimioter 2016; 29(6):332-335 [pdf]

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Rev Esp Quimioter 2017, 30(2):123-126

Pulmonary co-infection due to Nocardia cyriacigeorgica and Aspergillus fumigatus                     

ROCÍO TRASTOY, TAMARA MANSO, XANA GARCÍA, GEMA BARBEITO, DANIEL NAVARRO, PEDRO RASCADO, Mª LUISA PÉREZ DEL MOLINO           

Introduction. Pulmonary nocardiosis is an uncommon pulmonary infection caused by aerobic gram-positive bacteria of the genus Nocardia.  Nocardia sp. are environmental organisms spread worldwide. Approximately 50 Nocardia species have been described to date, about 30 of which are known to cause human disease. Nocardia cyriacigeorgica was first reported in 2001.
Case report. We report a case of infection caused by N. cyriacigeorgica in a patient with B-cells non-Hodgkin lymphoma and diabetes mellitus. The microbiological findings reflect a possible co-infection by N. cyriacigeorgica and Aspergillus fumigatus.
Conclusions. Patient’s background and information related to risk factors are essential to detect the growth of Nocardia sp. in the laboratory. Furthermore, diagnosis of invasive pulmonary aspergillosis is particularly controversial, especially in intensive care units patients.  Taking everything into account, we will discuss a possible co-infection by N. cyriacigeorgica and A. fumigatus in a critically ill patient.

Rev Esp Quimioter 2017; 30(2):123-126  [pdf]

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Rev Esp Quimioter 2015:28(2):101-108

Genotypic and phenotypic diversity in Enterococcus faecalis: is agar invasion a pathogenicity score?                                 
 


FABIO CAFINI, FERNANDO GÓMEZ-AGUADO, MARÍA TERESA CORCUERA, CARMEN RAMOS, PEDRO BAS, LUIS COLLADO, MARÍA LUISA GÓMEZ-LUS, JOSÉ PRIETO              

 

Objectives. The main objective of the present study is to analyze different genotypic and phenotypic traits related to virulence in Enterococcus faecalis, as well as evaluated the agar invasion phenotype in a collection of isolates with different clinical origins. 
Material and methods. Seventy-nine E. faecalis isolates, with invasive and non-invasive clinical origins, have been used in this work. Presence of cytolysin activator (cylA), gelatinase (gelE), surface protein (esp), aggregation substance (asa1), endocarditis antigen (efaA), and collagen-binding protein (ace) have been analyzed by PCR. Phenotypic characterization included gelatinase activity, haemolysin production, biofilm formation and agar invasion. 
Results. All the isolates tested harboured at least one of the virulence determinants. The 95.5% of isolates from haematologic samples were positive for agar invasion test, significantly higher than isolates from non-invasive diseases. A significant reduction in relative invasion area was observed in three selected agar-invasive strains after 15 serial passages.
Conclusions. It has been observed a significant high prevalence of agar-invasion positive isolates among strains belonged to haematological samples. Agar invasiveness is reduced after adaptation of clinical isolates to laboratory conditions, showing that agar invasion phenotype can be modulate by culture conditions as other virulence factors observed in different bacterial species.

Rev Esp Quimioter 2015:28(2):101-108 [pdf]

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Rev Esp Quimioter 2015:28(Suppl. 1):5-7

Applicability of new diagnostic techniques in microbiology; technological innovation     

                        
RAFAEL CANTÓN, ELENA LOZA, JOSÉ ROMERO              

Different new techniques have been introduced in microbiology laboratories during the last years, including mass spectrometry and next generation sequencing. These techniques, in addition to automation, microfludics, nanotechnology and informatics, have impelled innovation in the prevention and management of patients with infectious diseases. These approaches are relevant for revitalization and consolidation Clinical Microbiology laboratories.

Rev Esp Quimioter 2015:28(Suppl. 1):5-7 [pdf]

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Rev Esp Quimioter 2015:28(5):247-255

A two-hour procedure for determining the susceptibility of enterococci and staphylococci to antibiotics by a colourimetric method     

                        
GABRIEL ALBERTO MARCH-ROSSELLÓ, MARÍA PURIFICACIÓN GUTIÉRREZ-RODRÍGUEZ, MARÍA SIMARRO-GRANDE, ANTONIO ORDUÑA-DOMINGO, MIGUEL ÁNGEL BRATOS-PÉREZA              

Introduction. Rapid determination of the antibiotic susceptibility test in bacteria remains a challenge for Clinical Microbiology laboratories.
Methods. An improvement in the colorimetric antimicrobial susceptibility testing performed with resazurin in enterococci and staphylococci has been carried out. The design of method was performed using two collection strains, which have a known susceptibility. This procedure was then validated against standard commercial methods on 15 strains of staphylococci and 15 strains of enterococci from patients.
Results. The essential agreement between the colorimetric method and commercial methods (E-test, MicroScan and VITEK2) was 100%.
Conclusion. Resazurin allows us to obtain a reliable antibiotic susceptibility test in staphylococci and enterococci in less than two hours.

Rev Esp Quimioter 2015:28(5):247-255 [pdf]

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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]

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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]

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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]

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