Rev Esp Quimioter 2016, 29(4):183-189

A program for optimizing the use of antimicrobials (PROA): experience in a regional hospital                     

JON UGALDE-ESPIÑEIRA, JAIONE BILBAO-AGUIRREGOMEZCORTA, AINHOA ZURIÑE SANJUAN-LÓPEZ, CARMEN FLORISTÁN-IMÍZCOZ, LUIS ELORDUY-OTAZUA, MARGARITA VICIOLA-GARCÍA          

Introduction. Programs for optimizing the use of antibiotics (PROA) or antimicrobial stewardship programs are multidisciplinary programs developed in response to the increase of antibiotic resistant bacteria, the objective of which are to improve clinical results, to minimize adverse events and to reduce costs associated with the use of antimicrobials. The implementation of a PROA program in a 128-bed general hospital and the results obtained at 6 months are here reported.
Methods. An intervention quasi-experimental study with historical control group was designed with the objective of assessing the impact of a PROA program with a non-restrictive intervention model to help prescription, with a direct and bidirectional intervention. The basis of the program is an optimization audit of the use of antimicrobials with not imposed personalized recommendations and the use of information technologies applied to this setting. The impact on the pharmaceutical consumption and costs, cost per process, mean hospital stay, percentage of readmissions to the hospital are described.
Results. A total of 307 audits were performed. In 65.8% of cases, treatment was discontinued between the 7th and the 10th day. The main reasons of treatment discontinuation were completeness of treatment (43.6%) and lack of indication (14.7%). The reduction of pharmaceutical expenditure was 8.59% (P = 0.049) and 5.61% of the consumption in DDD/100 stays (P=0.180). The costs by processes in general surgery showed a 3.14% decrease (p=0.000).
Conclusion. The results obtained support the efficiency of these programs in small size hospitals with limited resources.

Rev Esp Quimioter 2016; 29(4):183-189 [pdf]

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Rev Esp Quimioter 2016, 29(Suppl. 1):26-30

Resistant gram-negative bacteria. Therapeutic approach and risk factors                     

PATRICIA SALGADO, FERNANDO GILSANZ, EMILIO MASEDA          

The rapid spread of multidrug-resistant bacteria has become a serious threat, especially in critical care units, thereby prolonging the hospital stay. Enterobacteriaceae have a high capacity to adapt to any environment. Plasmids are the reason behind their expansion. The choice of empiric therapy for intra-abdominal or urinary infections requires knowledge of the intrinsic microbiological variability of each hospital or critical care unit, as well as the source of infection, safety or antibi-tic toxicity, interaction with other drugs, the dosage regimen and the presence of risk factors. Carbapenems are the drug of choice in the case of suspected infection by ESBL-producing Enterobacteriaceae. The new ceftazidime/avibactam and ceftolozane/tazobactam drugs are opening up promising new horizons in the treatment of multidrug-resistant Enterobacteriaceae.

Rev Esp Quimioter 2016; 29(Suppl. 1):26-30 [pdf]

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Rev Esp Quimioter 2016, 29(6):302-307

Demographic and clinical features of diagnosed individuals of enterobiasis in the southern Gran Canaria: sampling assessment                     

DEYANIRA CARRILLO-QUINTERO, LAURA DEL OTERO SANZ, SARA HERNÁNDEZ-EGIDO, ANTONIO MANUEL MARTÍN SÁNCHEZ          

Introduction. Enterobius vermicularis, also known as pinworn, is the responsible agent for Human Enterobiasis. It is one of the most prevalent, but underrated, parasitic disease in children population. Diagnosis involves demonstration of either eggs or adult worms by Graham test. The aim of this study is to describe the clinical, demographic and microbiological features of patients with suspected diagnosis of Enterobiasis in southern Gran Canaria.
Material and methods. Descriptive and prospective study of perianal samples evaluated by Graham test in the Microbiology Department of `Insular de Gran Canaria´ University Hospital between November 2014 and November 2015. Descriptive analysis to evaluate the correlation between clinical and demographic variables and the results of Graham test microbiological observation.
Results. 1,128 samples were analyzed. E. vermicularis was found in 11.4% of the samples. Among the positives samples, 88.4% belonged to children under 14 years, and 53.5% were male. Abdominal pain (18.6%), anal itching (11.6%), eosinophilia (8.5%) and intestinal parasitosis suspicion (7.8%) were the reasons of parasitological investigation request in positive samples. Nevertheless, a high proportion of the requests was not founded in a suspicious diagnosis or was unrelated to Enterobiasis.
Conclusions. Enterobiasis is a common disease in primary health care and is of great importance in Gran Canaria. Quality in sample collection as well as diagnosis suspicious information are necessary for a good microbiological analysis.

Rev Esp Quimioter 2016; 29(6):302-307  [pdf]

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Rev Esp Quimioter 2017, Feb 11

Prevalence of human papilloma virus in women in a population screening program                     

JOSÉ Mª EIROS, MÓNICA DE FRUTOS, LUIS LÓPEZ-URRUTIA, LOURDES VIÑUELA, CARMEN RAMOS, JOSÉ Mª JIMÉNEZ           

Introduction. The human papillomavirus (HPV), is necesary to cause a woman developing cervical cancer. The aim of the study is to estimate the prevalence of women with HPV infection, belonging to the program of prevention and early detection of cervical cancer of Castilla y 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. A total of 12,183 positive samples were obtained, showing a prevalence of 9.6 ‰, in the female population, with 95.0% confidence interval (CI) between 9.48 and 9.82. The prevalence undergoes a linear decrease with increasing age of women. And by studying the prevalence of different genotypes depending on the risk of cell transformation it is higher in high-risk genotypes at low risk.
Conclusions. The screening system for cervical cancer in Castilla y León is the only screening program implemented in Spain, including the detection of HPV, so that the study results are of great significance for future studies of prevalence of infection and evolution.

Rev Esp Quimioter 2017; Feb 11  [pdf]

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Rev Esp Quimioter 2015:28(3):132-138

A practice-based observational study on the use of micafungin in Surgical Critical Care Units                                 
 


EMILIO MASEDA, CARLOS A. GARCÍA-BERNEDO, ISABEL FRÍAS, JOSÉ-ALEJANDRO NAVARRO, JESÚS RICO, REYES IRANZO, JUAN-JOSÉ GRANIZO, MARÍA-JOSÉ VILLAGRÁN, ENRIC SAMSÓ, FERNANDO GILSANZ ON BEHALF OF THE MYCREA STUDY GROUP              

 

Introduction. Echinocandins are first-line therapy in critically ill patients with invasive Candida infection (ICI). This study describes our experience with micafungin at Surgical Critical Care Units (SCCUs).
Methods. A multicenter, observational, retrospective study was performed (12 SCCUs) by reviewing all adult patients receiving 100 mg/24h micafungin for ≥72h during ad-mission (April 2011-July 2013). Patients were divided by ICI category (possible, probable + proven), 24h-SOFA (<7, ≥7) and outcome.
Results. 72 patients were included (29 possible, 13 probable, 30 proven ICI). Forty patients (55.6%) presented SOFA ≥7. Up to 78.0% patients were admitted after urgent surgery (64.3% with SOFA <7 vs. 90.3% with SOFA ≥7, p=0.016), and 84.7% presented septic shock. In 66.7% the site of infection was intraabdominal. Forty-nine isolates were recovered (51.0% C. albicans). Treatment was empirical (59.7%), microbiologically directed (19.4%), rescue therapy (15.3%), or anticipated therapy and prophylaxis (2.8% each). Empirical treatment was more frequent (p<0.001) in possible versus probable + proven ICI (86.2% vs. 41.9%). Treatment (median) was longer (p=0.002) in probable + proven versus possible ICI (13.0 vs. 8.0 days). Favorable response was 86.1%, without differences by group. Age, blood Candida isolation, rescue therapy, final MELD value and %MELD variation were significantly higher in patients with non-favorable response. In the multivariate analysis (R2=0.246, p<0.001) non-favorable response was associated with positive %MELD variations (OR=15.445, 95%CI= 2.529-94.308, p=0.003) and blood Candida isolation (OR=11.409, 95%CI=1.843-70.634, p=0.009).
Conclusion. High favorable response was obtained, with blood Candida isolation associated with non-favorable response, in this series with high percentage of patients with intraabdominal ICI, septic shock and microbiological criteria for ICI.

Rev Esp Quimioter 2015:28(3):132-138 [pdf]

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Rev Esp Quimioter 2015:28(Suppl. 1):16-18

Usefulness of PK/PD parameters of antimicrobials in the treatment of complex and extremely-resistant infections     

                        
JUAN PABLO HORCAJADA              

Complex or difficult to treat infections should benefit from antimicrobial PK/PD data in each specific situation. In the case of multidrug resistant gram negative infections the optimized use of colistin needs the using of PK/PD indexes. Likewise, in infections of inaccessible sources, PK/PD concepts play a key role in choosing the best antimicrobial and dosage. An example would be the potential role of linezolid in CNS infections. Among fungal infections, symptomatic candiduria by fluconazole-resistant strains are a therapeutic challenge. In this context micafungin could be a good alternative, again based on PK/PD concepts.

Rev Esp Quimioter 2015:28(Suppl. 1):16-18 [pdf]

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Rev Esp Quimioter 2015:28(6):275-281

Liposomal formulations of amphotericin B: differences according to the scientific evidence     

                        
JOSÉ RAMÓN AZANZA, BELÉN SÁDABA, JOANA REIS              

This article presents an overview of the characteristics of liposomes as drug carriers, particularly in relation to liposomal formulations of amphotericin B. General features regarding structure, liposome-cell interactions, stability, encapsulation of active substances and elimination of liposomes are described. Up to the present time extensive efforts to produce similar or bioequivalent products of amphotericin B formulations, in particular in the case of liposomal amphotericin B, have been unsuccessful in spite of having a very similar composition and even an apparently identical manufacturing process. Guidelines for the development of generic liposomal formulations developed by the FDA and EMA are also summarized. Based on the available evidence of the composition of liposomes, any differences in the manufacturing process even if the same lipid composition is used may result in different final products. Therefore, it seems unreasonable to infer that all amphotericin B liposomal formulations are equal in efficacy and safety.

Rev Esp Quimioter 2015;28(6):275-281 [pdf]

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Rev Esp Quimioter 2016, 29(2):99-104

Development of a web application for recording bacterial etiologic agents and their antimicrobial susceptibility to improve the treatment of urinary tract infections and monitor resistance to antibiotics     

                        

FRANCISCO GÓMEZ-PALOMO, ANTONIO SORLÓZANO-PUERTO, CONSUELO MIRANDA-CASAS, JOSÉ MARÍA RODRÍGUEZ-RODRÍGUEZ, JOSÉ MARÍA NAVARRO-MARÍ, JOSÉ GUTIÉRREZ-FERNÁNDEZ             

Introduction. We describe the development of a web platform that provides an updated record of the etiology and antimicrobial susceptibility of the different microorganisms responsible for urinary tract infections.
Material and Methods. The MicrobDinamyc system (Francisco Soria Melguizo, SA, Madrid, Spain) is employed for the management of information derived from the urine culture results. The web application database automatically gathers the results of urine cultures conducted in the laboratory.
Results. The user can consult the distribution of bacterial etiologies and antimicrobial susceptibilities in the different clinical settings during a specific time window.
Conclusions. Using susceptibility data obtained in previous studies and stored on the web platform, it is possible to deduce the clinical activity of a given antibiotic in a specific setting.

Rev Esp Quimioter 2016; 29(2):99-104 [pdf]

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Rev Esp Quimioter 2016, 29(4):202-205

Antimicrobial susceptibility of Gram-negative bacilli of community acquired intra-abdominal infections in a hospital at Buenos Aires, Argentina                     

LAURA MORGANTI, EZEQUIEL CÓRDOVA, ELSA CASSINI, NORA GÓMEZ, LAURA LÓPEZ MORAL, MARCELA BADÍA, CLAUDIA RODRÍGUEZ          

Introduction. Community acquired complicated intra-abdominal infections (cIAI) are a common condition. Few data are available about the level of antimicrobial resistance of Gram-negative bacteria isolated from community acquired cIAIs in Argentina.
Methods. Retrospective-prospective observational study (March 2010 to February 2012). Gram-negative bacteria antimicrobial susceptibility of isolates from community acquired cIAIs were evaluated.
Results. During this period, a total of 85 patients were included and 138 pathogens were collected. Male sex: 58%. Median age: 33. Monomicrobial cultures were obtained in 49% of the cases. Ninety (65%) corresponded to Gram-negative organisms, and 48 (38%) to Gram-positive cocci. Gram-negative organisms most frequently observed were: Escherichia coli 76%, Klebsiella pneumoniae 8%, Pseudomonas aeruginosa 7% and Enterobacter spp. 6%. E. coli and K. pneumoniae showed a high percentage of strains resistance to ciprofloxacin of 37% and 29%, respectively. Similarly, resistance to ampicillin/sulbactam was observed in a 16% of the E. coli isolates. The prevalence of multiresistant Gram-negative organisms was 38%.
Conclusions. A high level of resistance to antimicrobials was observed in community acquired cIAIs, mainly to ciprofloxacin and ampicillin/sulbactam two of the most used antimicrobial for empirically treatment of cIAIs in our country. In addition a significant proportion of multiresistant Gram-negative organisms were identified.

Rev Esp Quimioter 2016; 29(4):202-205 [pdf]

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Rev Esp Quimioter 2016, 29(Suppl. 1):31-34

Approach to directed therapy after knowledge of the isolate: carbapenemase-producing Enterobacteriaceae, multidrug-resistant Pseudomonas aeruginosa and carbapenem-resistant Acinetobacter baumannii                     

JOSÉ ANTONIO MARTÍNEZ          

Directed treatment of infections due to multidrug-resistant Gram-negative bacilli is a difficult task, since it requires the use of a limited number of antibiotics that are often more toxic and possibly less efficacious than β-lactams and fluoroquinolones. Furthermore, there are very few controlled trials informing on the relative efficacy of different therapeutic strategies.  As a general rule, it is recommended to use at least two active drugs or a combination with proven synergistic activity in vitro, because several observational studies have associated this practice with better outcomes and as a measure to potentially curb the emergence of further resistance. It is already available a new cephalosporin active against most strains of Pseudomonas aeruginosa resistant to ceftazidime due to derepression of ampC and in the near future an effective inhibitor of class A, class C and OXA-48 will be available which combined with ceftazidime is expected to mean a significant addition to the armamentarium against Gram-negative bacilli with these resistance determinants.

Rev Esp Quimioter 2016; 29(Suppl. 1):31-34 [pdf]

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