Rev Esp Quimioter 2015:28(6):289-294

Surveillance of resistance of Staphylococcus aureus to antibiotics in Galicia: 2007-2012     

                        
MERCEDES TREVIÑO, ISABEL LOSADA, MARÍA ÁNGELES PALLARÉS, FRANCISCO JOSÉ VASALLO, AMPARO COIRA, BEGOÑA FERNÁNDEZ-PÉREZ, ISABEL PAZ, FERNANDA PEÑA, PATRICIA ALEJANDRA ROMERO, LUCÍA MARTÍNEZ-LAMAS, GAEL NAVEIRA, XURXO HERVADA              

Introduction. Since 2007 the Galician Surveillance Program on Antimicrobial Resistance has been collected data of Staphylococcus aureus susceptibility patterns. The data from 2007 to 2012 have been analyzed and are reported.
Methods. A total of 4,577 different isolates of S. aureus from cerebrospinal fluid and blood cultures were included. The Institutions involved provided the information about the susceptibility patterns, the assay methods used and the interpretative guidelines followed, and demographic data of patients.
Results. The rate of methicillin-resistance S. aureus (MRSA) was 22% in 2007-2010 and 26% in 2011-2012, although in some areas the percentage reached 57% (2007- 2010) or 66% (2011-2012). The higher rates of resistance were found in patients older than 75 years. Gentamycin resistance was less than 9% and for quinolones were about 25%. A strong association between methicillin and quinolone-resistance were observed (91%). The resistance against linezolid and glycopeptides were exceptional.
Conclusions. The percentage of MRSA has evolved slightly along the period of this study reaching no significant differences between Galicia and the global data in Spain in 2012. Nevertheless, there are significant differences among the geographic areas studied. Most MRSA isolates were recovered from hospitalized patients, but an increase in the number of MRSA among outpatients was observed, while old patients from nur-sing homes are included in the outpatient group, so the MRSA rate in this group could be overestimated.

Rev Esp Quimioter 2015;28(6):289-294 [pdf]

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Rev Esp Quimioter 2016, 29(2):91-98

Changes in the epidemiology of gastroenteritis caused by Salmonella during 2005-2014 in Salamanca, Spain    

                        

OLAIA CORES-CALVO, LUIS FÉLIX VALERO-JUAN, ENRIQUE GARCÍA-SÁNCHEZ, JOSÉ ELÍAS GARCÍA-SÁNCHEZ, MARÍA INMACULADA GARCÍA-GARCÍA             

Background. In Spain there are not many updated population studies about salmonellosis, despite being one of the most common etiologies of acute gastroenteritis (AGEs) caused by bacteria in the world. The aim of the study was to know the most relevant epidemiological features of AGEs produced by Salmonella spp. between 2005 and 2014 in Salamanca (Spain).
Methods. Descriptive cross-sectional study carried out through review of the clinical microbiologic records at Complejo Asistencial Universitario de Salamanca. Culture, isolation, identification and serotyping were performed according to standard methodology.
Results. Salmonella was isolated in 1,477 patients, representing 47.7% of all positive stool cultures and 53.3% of all income bacterial AGE. The average prevalence was 42.1 cases/100,000 people per year. The mean age was 23 ± 28 years and the median 7 years. 40.2% of all isolates occurred in children under 5 years, with an average prevalence of 45.1 cases/ 10,000 people per year. Overall, the most frequently isolated serotype was S. Typhimurium with 57%, followed by S. Enteritidis with 35.8%.
Conclusions. The prevalence of Salmonella decreased over time. The group aged 0-4 years had the highest rate throughout the period. However, Salmonella produced the highest percentage of hospitalizations for bacterial AGE. In recent years, S. Typhimurium serotype has replaced S. Enteritidis serotype and predominates in younger patients. It is observed under-reporting of cases of salmonellosis produced in Salamanca despite being mandatory notification of these since 2007.

Rev Esp Quimioter 2016; 29(2):91-98 [pdf]

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Rev Esp Quimioter 2016, 29(4):214-219

Tuberculous prosthetic knee joint infection: a case report and literature review                     

ANA LARA-OYA, Mª DEL CARMEN LIÉBANA-MARTOS, JAVIER RODRÍGUEZ-GRANGER,  ANTONIO SAMPEDRO-MARTÍNEZ, LUIS ALIAGA-MARTÍNEZ, JOSÉ GUTIERREZ-FERNÁNDEZ, JOSÉ Mª NAVARRO-MARÍ          

Introduction. Prosthetic late infection occurs in the second month after surgery in the context of haematogenous spread from another source. Prosthetic mycobacterial infection is a rare complication whose clinical management is not standardized.
Case. Patient of 77 years with no personal history except for diabetes and a prosthetic replacement of right knee with osteoarthritis three years ago.  Patient goes to hospital emergency box for 6 months pain in the right knee with mechanical inflammatory signs but no fever associated. After their return within 5 days and clinical worsening is reporting growth of Mycobacterium tuberculosis in knee aspirate and antitubercular treatment is established for 9 months. Nuclear magnetic resonance imaging studies also confirmed the diagnosis of tuberculosis spondylitis in the clinical context of the patients. After surgery, M. tuberculosis was again isolated from intraoperative samples and therefore the patient received another batch of treatment for 9 months. After a year of monitoring, the development was acceptable but few months later, the patient died for cardiovascular causes. In the literature review, 15 publications with a total of 17 clinical cases of prosthetic infection by M. tuberculosis were found from 1980 to 2014.    
Conclusion. Prosthetic tuberculous arthritis, although it is a rare presentation, it should be noted, especially in patients with predisposing conditions with a history of tuberculosis infection.

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Rev Esp Quimioter 2016, 29(Suppl. 1):39-42

Old and new antibiotics for therapy of multidrug resistant bacteria                     

VICENTE PINTADO          

The lack of new antibiotics for multidrug-resistant bacteria is a matter of concern in microorganisms such as Pseudomonas aeruginosa, ESBL- and carbapenemase-producing Enterobacteriaceae, Acinetobacter baumannii, methicillin-resistant Staphylococcous aureus and vancomycin-resistant Enterococcus faecium. This situation has conditioned the reuse of “old” antibiotics (colistin, fosfomycin), the use of more recent antibiotics with new indications or dosage regimens (tigecycline, meropenem) and the introduction of “new” antibiotics (β-lactams, lipoglycopeptides, oxazolidinones) that are the subject of this review.

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Rev Esp Quimioter 2016, 29(6):288-295

Determinants of parasite drug resistance in human lymphatic filariasis                     

FERNANDO COBO           

Infection with filarial nematodes remains endemic in several countries worldwide and some of these infections are commonly associated with severe disease. The elimination of lymphatic filariasis relies on drug administration using the three drugs currently available for treatment: diethylcarbamazine, albendazole, and ivermectin. However, development of drug resistance is a reported phenomenon. The issue of resistance to antihelminthics used in humans has become increasing importance since the global program to eliminate lymphatic filariasis is implemented in larger population groups and the duration of the program is increasing. Recently, ivermectin resistance has been reported in Ghana, and widespread of resistance to benzimidazole (such as albendazole) is present because specific mutations in the gene encoding β-tubulin have been associated with drug resistance. Moreover, it is well known that diethylcarbamazine susceptibility is not 100% for lymphatic filariasis treatment. A review of the mechanisms of resistance to these antihelminthics is necessary in order to optimize the treatment for human lymphatic filariasis.

Rev Esp Quimioter 2016; 29(6):288-295  [pdf]

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Rev Esp Quimioter 2017, 30(2):118-122

Pneumococcal arthritis in paediatric population                     

GEMA BARBEITO-CASTIÑEIRAS, MARÍA GUINDA-GIMÉNEZ, OLAIA CORES-CALVO,  MANUELA HERNÁNDEZ-BLANCO, FERNANDA PARDO-SÁNCHEZ           

Introduction. Cases of septic arthritis in paediatric population by Streptococcus pneumoniae in the Health Area of Santiago de Compostela (Spain) were reviewed.
Material and methods. A retrospective study from January 2005 to March 2014 was conducted for all S. pneumoniae isolates obtained from joint fluids in children.
Results. From the 7,416 joint fluids received in the Microbiology Department, 77 belonged to paediatric patients, and of these, only 8 had positive culture. In total, there were three positive cases for S. pneumoniae, two with positive culture and a third with positive antigen detection. In the three patients (two of them under 15 months) the affected joint was hip, antibiotic treatment was combined with surgical drainage and evolution was favourable.
Conclusions. We conclude that pneumococcal arthritis is an entity that must be taken into account since most cases of arthritis in paediatric population appear as a complication of bacteraemia after a common cold or an ear infection. The greatest risk of sequel is associated with delays in diagnosis, so it is essential clinical and microbiological early diagnosis.

Rev Esp Quimioter 2017; 30(2):118-122  [pdf]

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Rev Esp Quimioter 2015:28(1):10-20

Prevention of an outbreak of Acinetobacter baumannii in intensive care units: study of the efficacy of different mathematical methods                                 
 


MARÍA JOSÉ FRESNADILLO-MARTÍNEZ, ENRIQUE GARCÍA-MERINO, ENRIQUE GARCÍA-SÁNCHEZ, ÁNGEL MARTÍN-DEL REY, ÁNGEL RODRÍGUEZ-ENCINAS, GERARDO RODRÍGUEZ-SÁNCHEZ, JOSÉ ELÍAS GARCÍA-SÁNCHEZ              

Introduction. Although in past decades, Acinetobacter baumanni infections have been sporadically identified in hospitals, nowadays the nosocomial infections due to this pathogen have notably increased. Its importance is due to its multidrug-resistance, morbidity and mortatility in healthcare settings. Consequently, it is important to predict the evolution of these outbreaks in order to stablish the most efficient control measures. There are several experimental studies shown that the compliance with hand and environmental hygiene and the efficient management of the healthcare work help to control the evolution of these outbreaks. The goal of this work is to formally proof these experimental results by means of the analysis of the results provided by the model.
Methods. A stochastic mathematical model based on cellular automata was developed. The variables and parameters involved in it have been identified from the knowledge of the epidemiology and main characteristics of Acinetobacter infections.
Results. The model provides several simulations from different initial conditions. The analysis of these results proofs in a formal way that the compliance with hand and environmental hygiene and an efficient plannification of the work of healtcare workers yield a decrease in the colonized patients. Moreover, this is the unique model proposed studying the dynamics of an outbreak of A. baumanni.
Conclusions. The computational implementation of the model provides us an efficient tool in the management of outbreaks due to A. baumanni. The analysis of the simulations obtained allows us to obtain a formal proof of the behaviour of the measures for control and prevention.

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Rev Esp Quimioter 2015:28(3):154-156

Nebulized medication is not associated with nosocomial infections. A pilot study                                 
 


DAVID VINUESA, VIOLETA RAMOS, ALEJANDRO PEÑA, MARÍA RUIZ-RUIGÓMEZ, JON BADIOLA, LEOPOLDO MUÑOZ-MEDINA, JOSÉ HERNÁNDEZ-QUERO, JORGE PARRA-RUIZ              

 

Introduction. Nebulized devices are commonly used in the treatment of respiratory infection, and other respiratory diseases. It has been reported nosocomial infections in cystic fibrosis patients as a result of the use of contaminated devices. However, little is known about nosocomial infections secondary to aerosolized therapy in COPD patients admitted for acute exacerbation.
Methods. Thirty consecutive patients (13 males) were included. All of them received aerosolized medication.  Each patient used their own facemask and nebulizer cup, which were stored in the room after its use. Samples from nebulizer cups were obtained on days 0, 4 and 7. In addition, sputum samples were obtained on day 0 (prior to any nebulization) and on day 7, and cultivated in enriched media.
Results. Only nine nebulizer cups had positive microbiological cultures. Coagulase negative staphylococci (CoNS) were isolated in all cases. Sputum samples could be obtained in 27 patients. None grew CoNS after 7 days of aerosolized therapy. Gram-negative non-fermenting bacilli were isolated in three patients without concomitant grown in nebulizer cups.
Conclusions. We did not find any nosocomial infection related to aerosolize medications in COPD patients admitted for acute exacerbation.

 

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Rev Esp Quimioter 2015:28(Suppl. 1):30-33

Duration of antimicrobial therapy     

                        
JUAN PASQUAU, MAYRA MATESANZ              

The management of infectious diseases is always complex, not only because of its high incidence and mortality, but the difficulty of designing effective treatments that minimize the development of bacterial resistance in the clinical setting. One of the most important options is the reduction of exposure to antibiotic treatment, optimizing by desescalation and shortening the duration of therapy.

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Rev Esp Quimioter 2015:28(6):295-301

Analysis of the concordance of antibiotic treatment for patients with severe sepsis in emergencies     

                        
MARÍA ANTONIA PÉREZ-MORENO, BEATRIZ CALDERÓN-HERNANZ, BERNARDINO COMAS-DÍAZ, JORDI TARRADAS-TORRAS, MARCIO BORGES-SA              

Objectives. Antibiotic treatment is vital in patients with severe sepsis/septic shock. The objectives were to assess the degree of concordance between antibiotic prescribed in emergencies and post requirements; to relate it to health outcomes (mortality) and to analyze the reasons for disagreement.
Material and methods. Retrospective descriptive study of antibiotic treatment prescribed in emergencies and the subsequent treatment in patients with criteria of severe sepsis/septic shock in 2013. We collected patient demographic characteristics, infectious focus, antibiotic prescribed from emergencies and subsequent changes. It was considered concordant if there were no changes, if there were changes, but the initial antibiotic was right and suspensions for end of treatment. Mortality and evolution were analyzed.
Results. Six hundred patients were included. A 60% experienced changes respect to the antibiotic treatment initiated in emergencies (87.6% justified), with a degree of overall antibiotic concordance of 47.5% The mortality rate at end-point was 9.83%, with no statistically significant relationship with the degree of concordance (OR=0.864 (0.503-1.484)/χ2=0.28; p=0.597). Reasons for change of antibiotic:  clinical outcome (17.96%), change of spectrum (35.03%), de-escalation (41.32%), sequential therapy (8.68%). An 11% required ICU admission. Clinical outcomes: resolution of the disease (79.2%), readmission after 30 days (7.7%) and transfer to health centers (4.5%). The median hospital stay was 7 days.
Conclusions. The degree of concordance antibiotic was quite high, and the mortality rate was lower than that described in the literature, without relating to the discordance. The presence of concordance was associated with fewer readmissions and ICU admissions. The main reasons for disagreement were inadequate spectrum selection and change after microbiological crops.

Rev Esp Quimioter 2015;28(6):295-301 [pdf]

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