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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Rev Esp Quimioter 2015:28(6):302-309

Use of antibiotics at a University Clinic Hospital: effect of protocolized antibiotic treatment in the evolution of hospital patients with infections     

                        
JOAQUÍN GÓMEZ-GÓMEZ, ELISA GARCÍA-VÁZQUEZ, CRISTINA BONILLO, ALICIA HERNÁNDEZ-TORRES, MANUEL CANTERAS-JORDANA              

Objectives. To analyse factors associated to “failure” in patients under antibiotic (AB) treatment at a third level hospital.
Patients and methods. All patients receiving an AB treatment along April 2012 were prospectively observed and factors associated to failure were analyzed. Failure was defined as clinical or microbiological failure, relapse or death. Statistically significance was established as p<0.05.
Results. 602 of 1,265 admitted patients during the study month included an AB in their medical prescriptions, being 178 considered as prophylactic AB prescriptions, 342 empirical treatments and 82 directed treatments as empiric treatments. Ceftriaxone and levofloxacin were the most used AB; choice of empirical and directed treatments were in line with protocols in 71% (242 of 342 cases) and 67% (55 of 82), respectively. Of all the patients receiving antibiotics for therapy (n=424), 402 had infection criteria (in 22 cases antibiotic treatment was deemed unnecessary since the patient showed no infectious process). Of these, 292 (72%) showed a good evolution, while the others were considered as failed therapies, either because of microbiological persistence in 49 (12.8%), relapse in 31 (7.71%) and death in en 30 (7.46%). Factors associated to “failure” were Charlson score ≥3 (OR 3.35; 95%CI 1.602-7.009); empirical and/or directed treatment not in keeping with the protocol (OR 5.68; 95%CI 2.898-11.217); and infection by ESBL and/or ciprofloxacin resistant E. coli (OR 4.43; 95%CI 1.492-13.184).
Conclusions. A high rate of AB prescriptions in admitted patients correspond to empirical infection treatment,  being ceftriaxone and levofloxacin the most used AB. Inadequate empirical and/or directed treatment is associated to clinical or microbiological failure and death.

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Rev Esp Quimioter 2015:28(6):310-313

Clinical features and outcomes of aspiration pneumonia and non-aspiration pneumonia in octogenarians and nonagenarians admitted in a General Internal Medicine Unit     

                        
HÉCTOR PINARGOTE, JOSE MANUEL RAMOS, ALINA ZURITA, JOAQUÍN PORTILLA              

Introduction. Pneumonia is a common infectious disease and causes significant morbidity and mortality especially in elderly people. Aspiration as a cause of pneumonia is common in this population. The aim of our study was to describe the clinical features and outcomes of very old patients with aspiration pneumonia (AP) and comparing them with patients with non-AP. 
Material and methods. In this prospective cohort study, we analyzed old patients (≥80 years-old) with pneumonia admitted 2014 in the Department of General Internal Medicine.
Results. Seventy-six old patients with pneumonia were included in the study, and 46 (60.5%) met criteria of AP. Increasing levels of urea, creatinine and sodium and low estimated glomerular filtrate rate were more common among AP patients. In addition, severity of pneumonia scored by pneumonia severity index and CURB-65 score were significantly greater in AP than in non-AP patients. The 30-days mortality in AP was (44%) quite higher than in non-AP (32%). The only predictor of mortality was high level of sodium (odds ratio: 1.09; 95% confidence intervals: 1.00-1.18).
Conclusions. AP in octogenarian and nonagenarians showed higher levels of sodium and low estimated glomerular filtrate rate and higher severity of pneumonia and slightly higher mortality than non-AP.

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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.

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Rev Esp Quimioter 2015:28(6):317-321

Measurement of antimicrobial consumption using DDD per 100 bed-days versus DDD per 100 discharges after the implementation of an antimicrobial stewardship program     

                        
ROBERTO COLLADO, JUAN EMILIO LOSA, ELENA ALBA, ÁLVARO PIEDAD TORO, LEONOR MORENO, MONTSERRAT PÉREZ              

Introduction.  Monitoring antimicrobial consumption in hospitals is a necessary measure. The indicators commonly employed do not clearly reflect the antibiotic selection pressure. The objective of this study is to evaluate two different methods that analyze antimicrobial consumption based on DDD, per stay and per discharge, before and after the implementation an antimicrobial stewardship program.
Material and methods. Comparative pre-post study of antimicrobial consumption  with the implementation of an antimicrobial stewardship program using DDD per 100 bed-days and DDD per 100 discharges as indicators.
Results. Hospital bed days remained stable and discharges increased slightly along the period of study Antibiotic consumption in DDD per 100 bed-days decreased by 2.5% versus 3.8% when expressed as DDD per 100 discharges. Antifungal consumption decreased by more than 50%.
Conclusions. When average hospital stay decreases, reductions in the consumption of antimicrobials with an antimicrobial stewardship program system occur at the expense of reducing the number of patients receiving treatment, while increases occur due to longer durations of treatment.

Rev Esp Quimioter 2015;28(6):317-321 [pdf]

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Rev Esp Quimioter 2016,29(1):32-39

Intraabdominal candidiasis in surgical ICU patients treated with anidulafungin: A multicenter retrospective study     

                        
EMILIO MASEDA, MARTA RODRÍGUEZ-MANZANEQUE, DAVID DOMINGUEZ, MATILDE GONZÁLEZ-SERRANO, LORENA MOURIZ, JULIÁN ÁLVAREZ-ESCUDERO, NAZARIO OJEDA, PURIFICACIÓN SANCHEZ-ZAMORA, JUAN-JOSÉ GRANIZO, MARÍA-JOSÉ GIMÉNEZ, ON BEHALF OF THE PERI-OPERATIVE INFECTION WORKING GROUP OF THE SPANISH SOCIETY OF ANESTHESIOLOGY AND CRITICAL CARE              

Introduction. Patients with recent intraabdominal events are at uniquely risk for intraabdominal candidiasis (IAC). Candida peritonitis is a frequent and life-threatening complication in surgically ill patients. International guidelines do not specifically address IAC. This study describes clinical features of IAC in critical patients treated with anidulafungin in Surgical ICUs (SICUs).
Material and methods. A practice-based retrospective study was performed including all adults with IAC admitted to 19 SICUs for ≥24h treated with anidulafungin. IAC was documented (Candida isolation from blood/peritoneal fluid/abscess fluid and/or histopathological confirmation) or presumptive (host factors plus clinical criteria without mycological support). Total population and the subgroup of septic shock patients were analyzed.
Results. One hundred and thirty nine patients were included, 94 (67.6%) with septic shock, 112 (86.2%) after urgent surgery. Of them, 77.7% presented peritonitis and 21.6% only intraabdominal abscesses. Among 56.8% cases with documented IAC, C. albicans (52.8%) followed by C. glabrata (27.8%) were the most frequent species. Anidulafungin was primarily used as empirical therapy (59.7%), microbiologically directed (20.9%) and anticipated therapy (15.8%). Favourable response was 79.1% (76.6% among patients with septic shock). Intra-SICU mortality was 25.9% (28.7% among patients with septic shock).
Conclusions. Among IACs managed at SICUs, peritonitis was the main presentation, with high percentage of patients presenting septic shock. C. albicans followed by C. glabrata were the main responsible species. Anidulafungin treatment was mostly empirical followed by microbiologically directed therapy, with a favourable safety profile, even among patients with septic shock.

Rev Esp Quimioter 2016;29(1):32-39 [pdf]

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Rev Esp Quimioter 2016;29(1):1-7

Current status of drug treatment against the disease caused by the Ebola virus     

                        
JORDI REINA              

The recent epidemic of disease caused by the Ebola virus has highlighted the need to develop specific drugs and have to deal with this entity. According to virological analysis they have been designed to give you some new drugs and are proven to others might be effective against this virus.
The main lines of therapy are based on immunotherapy (convalescent serum of patients and specific monoclonal an-tibodies), antiviral drugs (favipiravir, BCX4430, brincidofovir), interfering RNAs (TKM-Ebola) and antisense oligonucleotides (morpholino phosphorodiamidate) and other drugs no antiviral (clomiphene NSC62914, FGI-103, amiloride and ouabain).
Existing studies are scarce and mainly in animal models and clinical trials have been inconclusive most by the drastic reduction in the number of new cases.
However, progress has been made in the biological knowl-edge of Ebola virus and have been located new therapeutic tar-gets for the future development of specific antiviral.

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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.

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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.

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Rev Esp Quimioter 2016;29(1):8-14

Ertapenem therapy for pneumonia requiring hospital admission in elderly people     

                        

ARTURO ARTERO, ÁNGEL ATIENZA, SARA CORREA, IAN LÓPEZ, ALEJANDRA FAUS, FRANÇESC PUCHADES, MANUEL MADRAZO             

 

 

Background. Few studies examined ertapenem for the treatment of pneumonia. This study aims to compare ertapenem with other antibiotics commonly used for the treatment of pneumonia requiring hospital admission in elderly patients in daily clinical practice.
Methods. We conducted an observational, retrospective case-control study, between January 2011 and January 2014, in a university hospital. Patients ≥65 years of age admitted to the hospital with pneumonia treated with ertapenem were included as cases. A control patient treated with antibiotics other than ertapenem, matched for age and pneumonia severity index (PSI), was enrolled for each case. Hospital mortality was the primary outcome.
Results. A total of 150 patients with a mean age of 84.1 years were studied. Ninety percent of patients had pneumonia PSI grade IV-V and 82.7% had one or more comorbidities. Healthcare-associated pneumonia (HCAP) and aspiration pneumonia were significantly higher in the ertapenem group (66.7% vs. 24.0%, p < 0.001 and 73.3% vs. 54.7%, p < 0.017, respectively), whereas malignancy was most common in the control group. There was no difference in the hospital mortality rate between ertapenem and control groups (20.0% vs. 20.0%, p = 0.500), after adjusting for HCAP, aspiration pneumonia and malignancy. Transfer from hospital to hospital at home was significantly higher in the ertapenem group (25.3% vs. 9.3%, p = 0.09).
Conclusions. Ertapenem is as effective as other antibiotics commonly used for the treatment of pneumonia requiring hospital admission in elderly people. Ertapenem is associated with a higher transfer to hospital at home.

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