Rev Esp Quimioter 2016, 29(3):123-129

Role of bacteriobilia in postoperative complications  

                    
CARLOS ARMIÑANZAS, TERESA TIGERA, DIEGO FERRER, JORGE CALVO, LUIS ANTONIO HERRERA, MARCOS PAJARÓN, MANUEL GÓMEZ-FLEITAS, MARÍA CARMEN FARIÑAS             

Introduction. At present there is a controversy regarding the impact of positive bile cultures on morbidity and mortality rates, and on the incidence of readmissions in patients with biliar disease. The aim of this study was to evaluate the role of bacteriobilia in postoperatory infections, mortality or readmissions in these patients.
Methods. The information was obtained from all patients with bile cultures admitted to Hospital Universitario Marqués de Valdecilla (Santander, Spain) from January to December 2011. Clinical, epidemiological and microbiological data and laboratory findings were analyzed. The patients were followed for two years.
Results. One hundred and fifty-two patients (65% men) were included. Mean age was 67 years (SD= 15 years). The most frequent diagnoses were acute cholecystitis (79%) and cholangitis (8%). Laparoscopic cholecystectomy was performed in 42% of patients, open cholecystectomy in 45% and percutaneous cholecystostomy in 8%. Bacteriobilia was present in 83 patients (55%). The most frecuent microorganisms isolated were Escherichia coli (31%), Enterococcus faecium (13%) and Klebsiella pneumoniae (13%). The initial antimicrobial agent was a carbapenem in 62 patients (44%) and piperacillin-tazobactam in 28 (18%). There were 39 postoperative infections (26%), 21 readmissions (14%) and 17 patients died during admission (11%). The presence of microorganisms in bile cultures was not a statistically significant predictor of neither complications nor readmissions.
Conclusions. Intra-operative bile cultures would allow guide early appropriate antibiotic treatment use in case of infection, or empiric antimicrobial therapy, however there was no correlation between bacteriobilia and postoperative infections, length of stay, mortality or readmissions.

Rev Esp Quimioter 2016; 29(3):123-129 [pdf]

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Rev Esp Quimioter 2016, 29(5):269-272

Prevalence and distribution of hepatitis B virus genotype D in Galicia (northwest of Spain): influence of age, sex and origin                     

JOSÉ JAVIER COSTA, JAVIER RODRÍGUEZ, JAVIER ALBA, ISIDRO RIVADULLA, MARÍA LUISA PÉREZ-DEL-MOLINO, ANTONIO AGUILERA          

Introduction. Phylogenetically, hepatitis B virus (HBV) is classified into genotypes and subgenotypes used for epidemiological studies. The aim of this study is to know the distribution of HBV subgenotypes D in our environment.
Patients and methods. From 401 patients HBV surface antigen positive, HBV DNA-positive, partial HBV-DNA S gene was amplified, sequenced and analysed using geno2pheno (hbv) (Max-Planck Institute) on line application.
Results. We found 259 (64.6%) patients with HBV genotype D: 53 not subgenotypable, 9 (4%) D1, 61 (30%) D2, 15 (7%) D3 and 121 (59%) D4. Patients with D1 subgenotype were, on average, 23 years younger (p = 0.0001), with a higher proportion of women (p < 0.05).
Conclusions. HBV subgenotype D4 was the most prevalent in our area. Patients with D1 subgenotype came from abroad were younger than the other subgenotypes and mostly women. These results show the interest of conducting studies at HBV subgenotype level.

Rev Esp Quimioter 2016; 29(5):269-272 [pdf]

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Rev Esp Quimioter 2016, 29(Suppl. 1):52-55

Diagnostic and therapeutic approach of intra-abdominal candidiasis                     

ANA MONTERO, FERNANDO GILSANZ, EMILIO MASEDA          

Invasive fungal disease is associated to a high mortality rate on critical ill patients. In the last decades an important epidemiological shift has been described. Early diagnosis and treatment are related with a better prognosis. The key factors lie in a set of predictive scores that allow to identify patients that will benefit of early treatment, as well as using diagnosis techniques that are culture independent. New diagnosis ap-proximations are being developed with promising results: in situ hybridisation using PNA-FISH probes, MALDI-TOF MS and rapid nucleic acids detection assays. The use of echinocandin is recommended as antifungal therapy on critical ill patients with candida peritonitis.

Rev Esp Quimioter 2016; 29(Suppl. 1):52-55 [pdf]

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Rev Esp Quimioter 2017; 30(1):45-49

Evaluation of an immunochromatographic test for the detection of OXA-48 carbapenemase                     

CONCEPCIÓN MEDIAVILLA-GRADOLPH, ROCÍO SÁINZ-RODRIGUEZ, MIRIAM VALVERDE-TROYA, INMACULADA DE TORO-PEINADO, Mª PILAR BERMUDEZ-RUÍZ, BEGOÑA PALOP-BORRÁS           

Introduction. Detection and differentiation of various types of carbapenemases is crucial to their control and dissemination. OXA -48 is the most common carbapenemase in Spain and in our environment. The aim of this study is the evaluation of a new immunochromatographic test OXA-48 Card letitest (Coris, BioConcept Belgium) to detect this carbapenemase from solid media.
Material and Methods. During the last year 151 strains of carbapenemase producing bacteria have been isolated, of which 136 were OXA-48 (126 Klebsiella pneumoniae, 1 Klebsiella oxytoca, 5 Escherichia coli, 4 Enterobacter cloacae), and 15 producing other carbapenemases . These 15 strains with other 73 carrying other resistance mechanisms (54 extended-spectrum β-lactamases producers and 19 with other mechanisms) were used as negative controls.
Results. One hundred and thirty six strains carrying OXA-48 were positive with the test OXA-48 Card letitest and the 88 species used as controls were negative, resulting in a sensitivity and specificity of 100%.
Discussion. The OXA-48 Card letitest is simple, quick, safe and cheap (approx. 6€/test) and can be used in microbiology laboratories to confirm the production of OXA-48 carbapenemase in clinical isolates.

Rev Esp Quimioter 2017; 30(1):45-49  [pdf]

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Rev Esp Quimioter 2017, 30(2):90-95

Resistance rates and phenotypic characterization of Streptococcus pyogenes in a paediatric population in Northern Spain (2005-2015)                     

LAURA CALLE-MIGUEL, CARLOS PÉREZ-MÉNDEZ, MARÍA DOLORES MIGUEL-MARTÍNEZ, EMMA LOMBRAÑA-ÁLVAREZ, ELISA GARCÍA-GARCÍA, GONZALO SOLÍS-SÁNCHEZ           

Background. Streptococcus pyogenes is a significant cause of bacterial infections in children. The aim of the study is to analyse resistance rates and phenotypes of S. pyogenes isolates in a paediatric population in Northern Spain over the last 11 years.
Methods. Descriptive retrospective study of S. pyogenes isolates from paediatric patients between 2005 and 2015 in a region of Asturias (Spain). Resistance rates and changes in erythromycin resistance phenotypes in two time periods (2005-2009 and 2010-2015) were studied.
Results. A total of 1,794 S. pyogenes isolates were registered (70% from 2005 to 2009). 87.5% were obtained from pharyngeal swabs and 0.2% from blood  cultures. Resistance rates to tetracycline (8.8% to 4.3%, p=0.02), erythromycin (22% to 9.3%, p<0.01) and clindamycin (6% to 1.7%, p<0.01) decreased between the two study periods. A reduction in erythromycin-resistant isolates with the MLSB phenotype was observed.
Conclusions. A decrease in S. pyogenes resistance rates to erythromycin and clindamycin and a change in the erythromycin resistance phenotype were observed along the study period.

Rev Esp Quimioter 2017; 30(2):90-95 [pdf]

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Rev Esp Quimioter 2015:28(1):36-38

Salmonella enterica with nonclassical quinolone resistance phenotype in pediatric patients                                 
 


Mª JOSÉ GONZÁLEZ-ABAD, MERCEDES ALONSO-SANZ              

 

Introduction. Decreased susceptibility to fluoroquinolones in Salmonella spp. may lead to treatment failures. The use of ciprofloxacin for extraintestinal and serious intestinal Salmonella infections in children is controversial and therefore the clinical relevance of these strains is not significant. Consequently little is know about the quinolone resistance of strains Salmonella of our paediatric population. The objective of this study was to assess the incidence of nonclassical quinolone resistance phenotype in paediatric patients.
Material and methods. Two hundred and sixty eight Salmonella spp. from Hospital Infantil Universitario Niño Jesús of Madrid (2009-2013) were tested against nalidixic acid and ciprofloxacin by microdilution. Moreover, 146 strains (2011-2013) were tested against ciprofloxacin by E-test. Reduced ciprofloxacin susceptibility was defined as a MIC of 0.125-1 mg/L.
Results. Of 42 isolates with reduced ciprofloxacin susceptibility, four isolates showing nonclassical quinolone resistance phenotype. Three were confirmed as carrying of plasmid-mediated quinolone resistance-conferring genes qnr.
Conclusions. The percentage of strains with a genotype that confers a nonclassical quinolone resistance phenotype is low in our series. The identification of these isolates is difficult using conventional methods, but its ability of horizontal spread recommends an appropriate identification. Taking into account the low isolation rate of these strains in this study, evaluation of ciprofloxacin MIC on every nalidixic acid susceptible strain would not be cost effective. Alternatively, we propose to evaluate periodically any changing trend.

Rev Esp Quimioter 2015:28(1):36-38 [pdf]

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Rev Esp Quimioter 2015:28(4):183-192

Variability in antibiotic consumption within a regional health service, according to health area and model of healthcare coverage: national health system vs. civil servants’ mutual insurance society                                 
 

DIEGO PABLO SÁNCHEZ-MARTÍNEZ, JOSÉ JESÚS GUILLÉN-PÉREZ, FERNANDO IGNACIO SÁNCHEZ-MARTÍNEZ, ALBERTO MANUEL TORRES-CANTERO              

Introduction. The aim of this study is to describe antibiotic consumption in the Region of Murcia in 2011, within the Spanish and European context, as well as to analyze the differences within the Region, both between health areas, and between users of the regional health service and those protected by the civil servants’ mutual insurance society (MUFACE).
Methods. Retrospective observational study of prescriptions dispensed by the pharmacies in the Region of Murcia during 2011. Consumption rates were expressed as defined daily doses (DDD) per 1,000 inhabitants/day and standardized consumption ratios (SCR).
Results. Overall antibiotics consumption rate in the Region of Murcia in 2011 was 30.05 DDD/1000/ day (DID), which is much above the average rate for Spain (20.9 DID) and for the European Union (21.57 DID). Health areas within the Region with the highest and lowest consumption rate are, respectively, Vega Alta (SCR: 124.44; CI95% 124.26 to 124.61) and Cartagena (SCR:84.16; CI95% 84.10 to 84.22). Civil servants covered by the mutual society have higher consumption rates than users of the regional health service (SCR: 105.01; CI95% 104.86 to 105.17).
Conclusions. There is a high level of antibiotic prescription in the Region of Murcia Region in relative terms. A great variability in antibiotics consumption was observed between the different health areas, which might be related to the higher rate of the frequency of visits. The highest amount of variability in antibiotics prescription was found in cephalosporins and macrolides.

Rev Esp Quimioter 2015:28(4):183-192 [pdf]

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Rev Esp Quimioter 2015:28(Suppl. 1):43-47

Update on Ebola virus infection     

                        
 JUAN C. HURTADO, MIGUEL J. MARTÍNEZ              

Ebola virus disease became a major global public health concern after the last outbreak originated in West Africa in 2014. The epidemic has affected 10 countries in 3 continents, with an estimated global mortality of 41%, highlighting how a disease known to be restricted to the African continent can affect directly or indirectly many countries in the world. In this work, we review different aspects of the virus, the disease and the current outbreak.

Rev Esp Quimioter 2015:28(Suppl. 1):43-47 [pdf]

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Rev Esp Quimioter 2015:28(6):314-316

Seroprevalence of hepatitis E virus in patients with hepatitis C and / or infected with HIV     

                        
Mª FÁTIMA LÓPEZ-FABAL, JOSÉ LUÍS GÓMEZ-GARCÉS              

Introduction. Hepatitis E virus (HEV) can cause chronic infection and cirrhosis. The seroprevalence data of anti-HEV IgG in the patients infected with HIV or with chronic liver disease are scarce.
Methods. To document the seroprevalence of HEV infection in HIV patients or with chronic liver disease population, a retrospective study in serum samples from 625 patients was carried on: 200 HIV infected, 200 HCV infected, 25 coinfected by HIV and HCV and 200 healthy controls. Anti-HVE IgG antibodies were determined in serum samples by a commercial immunoassay (EIA) and all positive samples were studied further for the presence of anti-HEV IgM antibodies (HEV IgM 3.0; DiaSorin, Turín, Italy). Positive HEV IgM antibody specimens were examined for HEV RNA by polymerase chain reaction.
Results. Anti-HEV IgG were reactive in 25 (12.5%) of the 200 HIV-infected patients, in 47 out of 200 HCV infected patients (23.5%), 10 out of 25 coinfected HIV-HCV group (40%) and 24 out of 200 healthy controls (12%). According to EIA anti-HEV IgM, 11 patients could be considered as acute hepatitis E cases but in only one of them was confirmed recent HEV infection by RT-PCR.
Conclusions. The higher seroprevalence was found in HIV-HCV coinfected patients. The only patient with HEV RNA was HIV-HCV coinfected.

Rev Esp Quimioter 2015;28(6):314-316 [pdf]

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Rev Esp Quimioter 2016, 29(3):155-158

Clinical interest of Streptococcus bovis isolates in urine 

                    
JAVIER DE TERESA-ALGUACIL, MIGUEL GUTIÉRREZ-SOTO, JAVIER RODRÍGUEZ-GRANGER, ANTONIO OSUNA-ORTEGA, JOSÉ MARÍA NAVARRO-MARÍ, JOSÉ GUTIÉRREZ-FERNÁNDEZ             

Introduction. Streptococcus bovis includes variants related to colorectal cancer and non-urinary infections. Its role as urinary pathogen is unknown. Our objective was to assess the presence of urinary infection by S. bovis, analysing the patients and subsequent clinical course.
Material and Methods. Observational study, with longitudinal data collection, performed at our centre between all the cultures requested between February and April 2015. Clinical course of the patients and response to treatment were analysed.
Results. Two thousand five hundred and twenty urine cultures were analysed, of which 831 (33%) had a significant microbial count. S. bovis was isolated in 8 patients (0.96%). In 75% of these cases the urine culture was requested because of urinary tract infection symptoms; the remaining 25% because of fever of uncertain source; during the follow-up period no evidence of cancer or endocarditis was detected. S. gallolyticus subspecie pasteurianus was the only variant observed (100%). The clinical response to initial treatment was favourable in all cases.
Conclusions. S. bovis bacteriuria may have clinical significance, especially when S. gallolyticus subspecies pasteurianus is isolated in cases with underlying urinary tract disease.

Rev Esp Quimioter 2016; 29(3):155-158 [pdf]

 

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