Rev Esp Quimioter 2016;29(1):25-31

Dual therapy as an alternative treatment in HIV pretreatred patients: experience in a tertiary hospital     

                        
 LUCIA YUNQUERA-ROMERO, ROCÍO ASENSI-DÍEZ, MACARENA GAJARDO-ÁLVAREZ, ISABEL MUÑOZ-CASTILLO              

Introduction. Dual therapy regimen might be an effective alternative to prevent the occurrence of side effects and comorbidities associated with prolonged treatment with antiretroviral (ARV) and a way of simplification of antiretroviral therapy (ART) to improve adherence in certain patients. It also represents a potential treatment option for patients who have failed previous TAR.
Methods. The aim of the study is to describe the effectiveness, adherence and costs of dual therapy regimen used in pretreated HIV patients in tertiary hospital.
Results. Thirty-eight patients were studied (eight were excluded). Reasons for simplification to dual therapy were previous treatment toxicity (40%), simplification (36.67%) and virological rescue (20%). The dual therapy regimens most used were: IP/r + INSTIs (26.67%), IP/r + NRTIs (23.33%), IP/r + NNR-TIs (23.33%), IP/r+ CCR5 (16.66%) e INSTIs + NNRTIs (10%). ARV more used were darunavir/ritonavir (DRV/r) + raltegravir (23.33 %); DRV/r + lamivudine (20%) y DRV/r + etravirine (16.67 %). Adherence was 86.79% before switching to dual therapy and 96.27% after switching. The cost savings of switching to dual therapy of these patients was € 3,635.16.
Discussion. Dual therapy with IP/r might be an effective alternative to selected treatment experienced patients compared with conventional therapy.

Rev Esp Quimioter 2016;29(1):25-31 [pdf]

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Rev Esp Quimioter 2016, 29(3):151-154

Identification and in vitro antifungal susceptibility of vaginal Candida spp. isolates to fluconazole, clotrimazole, and nystatin   

                    
MARIA CRISTINA DIAZ, ROSSANNA CAMPONOVO, INGRID ARAYA, ANN CERDA, MARÍA PAOLA SANTANDER, ALFONSO-JAVIER CARRILLO-MUÑOZ             

Objective. The aim of this study was to identify and determine the in vitro antifungal susceptibility testing to clotrimazole, fluconazole, and nystatin of 145 clinical isolates of Candida spp.
Material and methods. M27-A3 microdilution method was used to determine minimal inhibitory concentrations (MIC) and partial MICs (MIC50 and MIC90) of drugs. A total of 145 isolates were studied, 126 were C. albicans, 16 C. glabrata, 2 C. parapsilosis y 1 C. tropicalis.
Results. MIC50 and MIC90 for FLZ against C. albicans were 0.25 mg/L and 1 mg/L respectively and for C. glabrata was achieved at 8 mg/L and 16 mg/L for fluconazole. Five isolates of C. albicans and one isolate of C. tropicalis were in vitro resistant to fluconazole (M27-S4). In C. albicans MIC50 and MIC90 for clotrimazole were of 0.03 mg/L and 0.06 mg/L, respectively. These values for C. glabrata were 0.25 mg/L and 1 mg/L, respectively. Five C. glabrata and 1 C. tropicalis were in vitro resistant to clotrimazole. MIC50 and MIC90 of nystatin were of 1 mg/L and 2 mg/L, respectively for C. albicans and C. glabrata.
Conclusion. In this study, C. albicans is the most frequently isolated yeast, followed by C. glabrata. The antifungals tested were found to be in vitro active for the isolates, except for 6 isolates for fluconazole and 6 to clotrimazole.

Rev Esp Quimioter 2016; 29(3):151-154 [pdf]

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Rev Esp Quimioter 2016, 29(Suppl. 1):1-5

Update in Infectious Diseases 2016                     

FRANCISCO JAVIER CANDEL, ANA BELÉN GARCÍA-GARCÍA, MARINA PEÑUELAS, ANA GARCÍA-ALVAREZ, FLAVIA CHIARELLA, LAURA LÓPEZ-GONZÁLEZ, CRISTINA GARCÍA-SALGUERO, CLARA LEJÁRRAGA, ICIAR RODRÍGUEZ-AVIAL          

Antimicrobial resistance increases it health, social and economic impact. in all areas (state, regional and local), initiatives to try to contain the problem of resistance arise. In the update of this year 2016, we study microbiological, epidemiological and clinical aspects of multi-resistant bacteria, as well as resources for therapeutic approach, from ancient to modern drugs from therapeutic combinations to optimization Stewardship programs. In the case of fungal infection, we analyze clinical scenarios with different species in yeast or new clinical settings in filamentous fungi. Taking paediatric population, homologies and differences with adults in invasive fungal infection were compared. Finally in the field of parasitology, treatment of severe malaria imported or that resistant to antimalarial drugs were reviewed.

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Rev Esp Quimioter 2016, 29(5):259-264

The use of ertapenem for the treatment of community-acquired pneumonia in routine hospital practice: a matched cohort study                     

DOLORES SOUSA, JOSÉ MARÍA BRAVO-FERRER, TERESA SEOANE-PILLADO, PATRICIA VÁZQUEZ-RODRÍGUEZ, LUCÍA RAMOS-MERINO, JOSÉ MARÍA GUTIÉRREZ-URBÓN, SALVADOR PITA, PEDRO LLINARES          

Background. The clinical response to ertapenem in community-acquired pneumonia (CAP) at the setting of routine hospital practice has been scarcely evaluated.
Methods. We retrospectively compared CAP cases treated with ertapenem or with other standard antimicrobials (controls) at a tertiary 1,434-bed center from 2005 to 2014.
Results. Out of 6,145 patients hospitalized with CAP, 64 (1%) ertapenem-treated and 128 controls were studied (PSI IV-V 72%, mean age 73 years.). A significant higher proportion of bedridden patients (41% vs. 21%), residence in nursing homes (19% vs. 7%), previous use of antibiotics (39% vs. 29%) and necrotizing (13% vs. 1%) or complicated (36% vs. 19%) pneumonia, was observed in the ertapenem vs. non-ertapenem patients. Initial treatment with ertapenem was independently associated with an earlier resolution of signs of infection. In patients aged 65 or older the independent risks factors for mortality were: PSI score (7.0, 95%CI 1.8-27.7), bedridden status (4.6, 95%CI 1.1-20.9) and Health Care Associated Pneumonia (HCAP) (4.6, 95%CI 1.3-16.5). First-line treatment with ertapenem was an independent protector factor in this subgroup of patients (0.1, 95%CI 0.1-0.7).
Conclusions. Ertapenem showed a superior clinical response in frail elderly patients with complicated community-acquired pneumonia, and it may be considered as a first-line therapeutic regimen in this setting.

Rev Esp Quimioter 2016; 29(5):259-264 [pdf]

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Rev Esp Quimioter 2017; 30(1):62-78

Diagnosis and treatment of imported eosinophilia in travellers and immigrants: Recommendations of the Spanish Society of Tropical Medicine and International Health (SEMTSI)                    

JOAQUÍN SALAS-CORONAS, GERMÁN RAMÍREZ-OLIVENCIA, JOSÉ LUIS PÉREZ-ARELLANO, MONCEF BELHASSEN-GARCÍA, CRISTINA CARRANZA-RODRÍGUEZ, MAGDALENA GARCÍA-RODRÍGUEZ, JUDIT VILLAR-GARCIA, BEGOÑA TREVIÑO-MARURI, NURIA SERRE-DELCOR, ROGELIO LÓPEZ-VÉLEZ, FRANCESCA NORMAN, JOAN GÓMEZ-JUNYENT, MANUEL JESÚS SORIANO-PÉREZ, GERARDO ROJO-MARCOS, ESPERANZA RODRÍGUEZ DE LAS PARRAS, MARÍA DEL MAR LAGO-NÚÑEZ, ANTONIO MURO, JOSÉ MUÑOZ           

According to published data, prevalence of imported eosinophilia among travellers and immigrants is set between 8% and 28.5%. Etiological diagnosis is often troublesome, and depending on the depth of the study and on the population analyzed, a parasitic cause is identified in 17% to 75.9% of the individuals. Among the difficulties encountered to compare studies are the heterogeneity of the studied populations, the type of data collection (prospective/retrospective) and different diagnostic protocols. In this document the recommendations of the expert group of the Spanish Society of Tropical Medicine and International Health (SEMTSI) for the diagnosis and treatment of imported eosinophilia are detailed.

Rev Esp Quimioter 2017; 30(1):62-78  [pdf]

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Rev Esp Quimioter 2017, Apr 5

Epidemiological surveillance for multidrug-resistant microorganisms in a general ICU                     

ANA FERNÁNDEZ-VERDUGO, JAVIER FERNÁNDEZ, DOLORES ESCUDERO, LUIS COFIÑO, LORENA FORCELLEDO,  MAURICIO TELENTI, EMILIO GARCÍA-PRIETO, RAQUEL RODRÍGUEZ-GARCÍA, LAURA ÁLVAREZ-GARCÍA, ANA PÉREZ-GARCÍA, CARLOS RODRÍGUEZ-LUCAS, FERNANDO VAZQUEZ           

Introduction. Multidrug resistant (MDR) microorganisms represent a threat for patients admitted in Intensive Care Units (ICUs). The objective of the present study is to analyse the results of epidemiological surveillance cultures for these microorganisms in one of these units.
Material and methods. General ICU. Retrospective analysis, descriptive statistics. Analysis of epidemiological surveillance cultures for MDR microorganisms in 2015. Studied microorganisms: Methicillin-resistant Staphylococcus aureus (MRSA), ESBL-and/or carbapenemase-producing Klebsiella pneumoniae (CESBL-KP) and MDR Acinetobacter baumannii (MDRAB).
Results. One thousand, two hundred and fifty nine patients admitted. A total of 2,234 specimens from 384 patients were analysed (690, 634, 62 and 286 were rectal, throat, nasal and skin swabs respectively). Global APACHE II was 18.3 ± 8 versus 21.7 ± 7.8 in patients colonized/infected on admission. Global mortality was 19.7% versus 22.3% in patients colonized/infected on admission. The higher sensitivities achieved with the different samples for the different microorganism detection were as follows. MRSA: 79% and 90% for nasal and nasal + throat swabs, respectively. MDRAB: 80% and 95% for throat and throat + rectal swabs, respectively. CESBL-KP: 95% and 98% for rectal and rectal + throat swabs, respectively. 94 out of the 384 patients (24.4%) were colonized/infected with MDR at admission. 134 patients (10.6% of the total patients admitted) were colonized/infected with a total of 169 MMR during the hospital stay. MRSA has the earliest colonization/infection (9.2 ± 6.4days) and ESBL-producing Enterobacteriaceae, the latest (18.7± 16.4 days).
Conclusions. 24.4% of patients were colonized/infected by MDR at admission. Nasal, throat and rectal swabs were the most effective specimens for recovering MRSA, MDRAB and CESBL-KP, respectively. The combination of two specimens improves MDR detection except for CESBL-KP. Skin swabs are worthless. The most prevalent MDR at admission were ESBL-producing Enterobacteriaceae while the most frequent hospital acquired MDR was MDRAB.

Rev Esp Quimioter 2017; Apr 5 [pdf]

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Rev Esp Quimioter 2015:28(2):92-97

Mortality among methicillin-resistant Staphylococcus aureus carriers in long-term care facilities                                  
 


ESTER VENDRELL, JOSEP A CAPDEVILA, PILAR BARRUFET, LLUÍS FORCE, GORETTI SAUCA, ENCARNA MARTÍNEZ, ELISABET PALOMERA, MATEU SERRA-PRAT, JORDI CORNUDELLA, ANNABEL LLOPIS, MªASUNCIÓN ROBLEDO, CRISÓSTOMO VÁZQUEZ              

 

Introduction. Little is known about the natural course of patients with chronic stable illnesses colonized with methicillin-resistant Staphylococcus aureus (MRSA). The aim is to determine the impact of MRSA colonization in mortality among long-term health care facility (LTHCF) residents.
Method. A multicenter, prospective, observational study was designed. Residents in 4 LTHCFs were classified according to MRSA carriage status and followed for 12 months. Treatment consisted of 5 days of nasal mupirocin in MRSA carriers.
Results. Ninety-three MRSA-carriers among 413 residents were identified. Thirty-one MRSA-colonized patients died during the study period, 11 of whom from an infectious disease. Independent predictors of their higher mortality rates included heart failure, current neoplasm, MRSA carriage and COPD at 3 months and these same factors plus stroke, Bar-thel index <40, pressure ulcers, and older age at 12 months. MRSA-persistence was 35% and 62.5% at 3 and 12 months, respectively.
Conclusions. MRSA colonization among frail LTHCFs residents is highly prevalent, and is associated with higher mortality. Despite treatment of MRSA carriers, many remained colonized. Factors that promote persistence of MRSA colonization, and the impact of their modification on mortality rates in these patients, need further investigation.

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Rev Esp Quimioter 2015:28(4):214-216

Could ceftaroline be an alternative therapy for linezolid resistant Staphylococcus epidermidis infections in Intensive Care Medicine?     

                        
FRANCISCO JAVIER CANDEL, ELVIRA BAOS, MERCEDES NIETO, JUAN JOSÉ PICAZO              

Introduction. Coagulase negative Staphylococcus continues generating interest in critically ill patients, due to their infections in extended admissions, in instrumented patients and due to their described multidrug resistance, which include glycopeptide heterorresistance and the increase in oxazolidinone resistance. Ceftaroline is a new cephalosporin with activity against resistant gram-positives, which, being betalactam, may provide adequate safety profile in the critical ill patient. The aim of this study was to determine the activity of ceftaroline and other antimicrobial agents against methicillin and linezolid-resistant Staphylococcus epidermidis.
Material and methods. We studied susceptibility of ceftaroline, tigecycline, daptomycin and vancomycin in a total of sixty-eight methicillin and linezolid-resistant S. epidermidis isolates with clinical significance from an Intensive Care Unit, using E-test.
Results. All strains were susceptible to the four antimicrobial agents, regardless of the level of resistance to linezolid.
Conclusion. Ceftaroline could be an alternative in the treatment of methicillin and linezolid-resistant S. epidermidis infections in critically ill patients.

Rev Esp Quimioter 2015:28(4):214-216 [pdf]

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Rev Esp Quimioter 2015:28(5):235-241

Boosted protease inhibitor monotherapy in HIV-infected patients: results of a study in a real life setting     

                        
NICOLÁS DI BENEDETTO, MARTA MONTERO-ALONSO, MARINO BLANES, JOSÉ LACRUZ, SANDRA CUELLAR, EVA CALABUIG, JOSÉ LÓPEZ, MIGUEL SALAVERT              

Background. Boosted protease inhibitor monotherapy may offer antiviral efficacy while reducing drug interactions, costs and toxicity. The aim of this study was to assess the efficacy of darunavir/ritonavir (DRV/r) and lopinavir/ritonavir (LPV/r) monotherapy in a real life setting.
Methods. A retrospective analysis of all HIV infected patients, who had initiated DRV/r or LPV/r monotherapy, was performed. Patients whose HIV viral load had remained undetectable for at least two consecutive follow-up visits and who had no neurocognitive disorder or hepatitis B co-infection, were included.
Results. Sixty patients were included. The median (IQR) time to follow-up was 66 (33-118) weeks. The proportions (CI95%) of patients with virological failure were 6.3% (1.7- 20.2) and 25.0% (12.7-43.4), respectively, in the DRV/r and LPV/r groups (p= 0.0424). The proportions (CI95%) of patients with therapeutic success were 90.6% (80.5-100) in the DRV/r group and 60.7% (42.6-78.8) in the LPV/r group (p=0.0063). No protease inhibitor mutations were detected. During the follow-up, 6 patients with dyslipidemia normalized their lipid values. The median monthly cost was 410 (IQR 242-416) euros per person lower for the monotherapy than for the combined antiretroviral therapy.
Conclusions. Boosted protease inhibitor monotherapy was effective in a real life setting. This study showed differences in favour of DRV/r as compared with LPV/r in terms of therapeutic success; however prospective studies are needed to confirm these results. Finally, although this study was not specifically designed to detect benefits in terms of costs and lipid profile, it shows evidence of a positive impact of monotherapy in these fields.

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Rev Esp Quimioter 2016,29(1):40-43

Adherence to international recommendations in the fight against antimicrobial resistance – Substantial difference between outpatient consumption in Spain and Denmark     

                        

SARA MALO, MARÍA JOSÉ RABANAQUE, LARS BJERRUM              

Introduction. Increasing antibiotic resistance represents a major public health threat that jeopardises the future treatment of bacterial infections. This study aims to describe the adherence to recommendations proposed by the World Health Organization (WHO) Advisory Group on Integrated Surveillance of Antimicrobial Resistance (AGISAR), in Spain and Denmark, and to analyse the relation between the outpatient use of Critically Important Antimicrobials (CIA) and the bacterial resistance rates to these agents.
Material and methods. The Antimicrobial consumption interactive database (ESAC-Net) and Antimicrobial resistance interactive database (EARS-Net) provided data on outpatient use (2010-2013) of CIA (fluoroquinolones, macrolides, and 3rd and 4th generation cephalosporins) and the percentages of isolates of the main pathogens causing serious infections, resistant to these agents.
Results. The use of cephalosporins and fluoroquinolones, as well as the percentage of bacteria resistant, is higher in Spain than in Denmark. Although consumption of macrolides in both countries is similar, the proportion of Streptococcus pneumoniae resistant to macrolides is significantly higher in Spain.
Conclusion. The high outpatient consumption of CIA agents in Spain deviates substantially from the WHO recommendations. Moreover, it has the effect of elevated rates of antimicrobial resistance, that are lower in Denmark.

Rev Esp Quimioter 2016;29(1):40-43 [pdf]

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