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]

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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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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]

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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]

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Rev Esp Quimioter 2015:28(3):125-131

The late media emergency of smallpox vaccine, news coverage of Spanish press (1999-2004)                                 
 


PEDRO JAVIER MARTÍNEZ-MARTINEZ,  JOSÉ TUELLS, GEMA COLMENAR-JARILLO              

 

Introduction. Discussions on the need for smallpox virus preservation in 1999 focused attention on an eradicated disease 20 years ago. Smallpox was replaced as a potential candidate to be used as a bioterrorist weapon because of the international alarm scenario produced after the 11/9 events in USA. The reactivation of a vaccine which remained forgotten was the direct consequence. The initial target groups were the security forces of America. Spain was also among the countries that were interested in acquiring the smallpox vaccine. The aim of this study is to analyze the considerable media coverage of smallpox obtained in our country.
Methods. Systematic review of published news in the four largest national daily newspapers (ABC, El Mundo, El País and La Vanguardia) for the period 1999-2004 of the Dow Jones Factiva document database. “Smallpox” were used as a key word. From the obtained data, a qualitative and quantitative analysis was done.
Results. 416 reviews were analyzed; the newspaper El Mundo was the most interested in these news (158 citations, 37.98%). Most of the news were published in 2003 (152, 36.5%) The year with more news about smallpox (2003) coincides with the purchase of vaccines in Spain. The type of messages in the news was highly changeable over this six-year period. Those related to “politics and diplomacy”, “epidemiological risk”, “bioterrorism” and “vaccine” were predominant.
Conclusions. The alarm raised around the smallpox vaccination was a media phenomenon due to political strategy issues rather than a real public health problem.

Rev Esp Quimioter 2015:28(3):125-131 [pdf]

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Rev Esp Quimioter 2015:28(Suppl. 1):12-15

Therapeutic options for carbapenemase-producing Enterobacteriaceae    

                        
PATRICIA SALGADO, FERNANDO GILSANZ, EMILIO MASEDA              

Carbapenemase-producing Enterobacteriaceae (CPE) has spread worldwide becoming a threat to public health. However, no randomized clinical trials about the efficacy of optimizing antibiotic treatment have been published. Experimental studies have been designed to find combinations of antibiotics with synergistic activity. Their main aim has been increasing the speed of bacterial destruction and decreasing resistance. The latest guidelines recommend combination therapy. The carbapenems has been chosen as the basis of such therapy. We face limited therapeutic options. Polymyxins, fosfomycin and gentamicin have reemerged in this context, becoming the basis of multiple combination regimens, with beneficial effects both in vitro and in murine models of infection.

Rev Esp Quimioter 2015:28(Suppl. 1):12-15 [pdf]

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Rev Esp Quimioter 2015:28(5):263-266

Evaluation of antibiotic resistance of Escherichia coli in urinary tract infections in Primary Care Barbastro Sector (Huesca)     

                        
ANA BETRÁN, ANA Mª CORTÉS, CONCEPCIÓN LÓPEZ              

Objectives. Evaluate the resistance of community-uropathogen, Escherichia coli to several antibiotics in our health sector and deduce empirical treatment options.
Methods. E. coli strains isolated from urine cultures of patients from Primary Care Barbastro Sector, between January 2011 and December 2013, were studied. The resistances rates for nine common antibiotics were determined, and differences in sensitivity were analyzed, comparing confidence intervals for proportions by the method of Wilson.
Results. E. coli was the most frequently isolated bacteria (61.08% of positive urine cultures sent from Primary Care). Overall, there has been an increase in resistance of E. coli isolates in all antimicrobials studied. Still, resistance has remained below 4% compared to fosfomycin and nitrofurantoin and below 10% in cephalosporins second and third generation. Resistance to amoxicillin-clavulanate has increased progressively reaching 21.5% in 2013; only this antibiotic has presented a statistically significant increase. The maximum levels of resistance (over 30%) were found in the antibiotics administered orally and often indicated in uncomplicated urinary tract infections: trimethoprim-sulfamethoxazole, ciprofloxacin and ampicillin.
Conclusions. Update knowledge susceptibility patterns of microorganisms most commonly isolated in urine samples in each health area allows to choose the most suitable and effective treatments trough empirical knowledge.

Rev Esp Quimioter 2015:28(5):263-266 [pdf]

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Rev Esp Quimioter 2016, 29(2):76-85

Knowledge and attitudes of healthcare workers towards a suspect case of Ebola virus disease     

                        

FRANCISCO J. GÓMEZ-ROMERO,  J. MANUEL GÓMEZ-GARCÍA, MERCEDES ARENCIBIA-JIMÉNEZ, JOSÉ ANTONIO DELGADO-DE LOS REYES, RUTH SARMIENTO-SEMPERE, ISIDRO GARCÍA-ABAD, RAMÓN VICEDO-CANO, GERARDO PÉREZ-TORREGROSA, JUAN FRANCISCO NAVARRO-GRACIA             

  

Introduction. The last outbreak of the Ebola virus disease, was a precedent to demonstrate the necessary training of healthcare personnel for possible eventualities of suspected cases of infectious diseases. It is required to study the level of qualification of healthcare workers in such situations.
Methods. Descriptive study using post-workshop survey of healthcare workers in a Valencian Community health department on acquired knowledge and skills after training.
Results and conclusions. Healthcare personnel received an overall passing score on the post-workshop survey, but with differences in occupational categories and different blocks of training. The ratings could be considered deficient in some cases. It should be reviewed periodically training health personnel and calibrate such training to the resources availa-ble for proper operation.

Rev Esp Quimioter 2016; 29(2):76-85 [pdf]

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