Rev Esp Quimioter 2016, 29(4):206-213

Changes in the epidemiology of Clostridium difficile infection during 2005-2014 in Salamanca, Spain                    

OLAIA CORES-CALVO, ENRIQUE GARCÍA-SÁNCHEZ, LUIS FÉLIX VALERO-JUAN, JOSÉ ELÍAS GARCÍA-SÁNCHEZ, MARÍA INMACULADA GARCÍA-GARCÍA          

Background. To know the most relevant epidemiological features of Clostridium difficile infection (CDI) between 2005- 2014 in the province of Salamanca (Spain).
Methods. Descriptive cross-sectional study carried out through review of the clinical microbiologic records at Complejo Asistencial Universitario de Salamanca. Detection was performed according to standard methodology.
Results. 2.6% of stool samples analyzed for detection of C. difficile toxins (9,103) were positive. The average prevalence was 6.8 cases per 100,000 people per year. The mean age was 65 ± 21.4 years and the median 70 years. 59% of cases occurred in patients over 64 years, with an average prevalence of 16.5 (4 times higher than the 15-64 group). Most cases (86.4%) occurred in hospitalized patients, and the group of over 64 had the highest percentage of hospital CDI, with 55%.
Conclusions. A significant increase in the number of requests and in the prevalence of CDI over the decade studied is observed, and prevalence rates were significantly lower than those of other studies. The percentage of CDI increased significantly in both inpatient and community. Age and hospitaliza-tion were risk factors for developing CDI. After the introduc-ion of a molecular detection technique in 2014, the prevalence increased, being 2.5 times higher than 2013.

Rev Esp Quimioter 2016; 29(4):206-213 [pdf]

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Rev Esp Quimioter 2016, 29(4):214-219

Tuberculous prosthetic knee joint infection: a case report and literature review                     

ANA LARA-OYA, Mª DEL CARMEN LIÉBANA-MARTOS, JAVIER RODRÍGUEZ-GRANGER,  ANTONIO SAMPEDRO-MARTÍNEZ, LUIS ALIAGA-MARTÍNEZ, JOSÉ GUTIERREZ-FERNÁNDEZ, JOSÉ Mª NAVARRO-MARÍ          

Introduction. Prosthetic late infection occurs in the second month after surgery in the context of haematogenous spread from another source. Prosthetic mycobacterial infection is a rare complication whose clinical management is not standardized.
Case. Patient of 77 years with no personal history except for diabetes and a prosthetic replacement of right knee with osteoarthritis three years ago.  Patient goes to hospital emergency box for 6 months pain in the right knee with mechanical inflammatory signs but no fever associated. After their return within 5 days and clinical worsening is reporting growth of Mycobacterium tuberculosis in knee aspirate and antitubercular treatment is established for 9 months. Nuclear magnetic resonance imaging studies also confirmed the diagnosis of tuberculosis spondylitis in the clinical context of the patients. After surgery, M. tuberculosis was again isolated from intraoperative samples and therefore the patient received another batch of treatment for 9 months. After a year of monitoring, the development was acceptable but few months later, the patient died for cardiovascular causes. In the literature review, 15 publications with a total of 17 clinical cases of prosthetic infection by M. tuberculosis were found from 1980 to 2014.    
Conclusion. Prosthetic tuberculous arthritis, although it is a rare presentation, it should be noted, especially in patients with predisposing conditions with a history of tuberculosis infection.

Rev Esp Quimioter 2016; 29(4):214-219 [pdf]

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Rev Esp Quimioter 2016, 29(5):255-258

Activity of linezolid and tedizolid against clinical isolates of methicillin-resistant and methicillin and linezolid resistant Staphylococcus aureus: an in vitro comparison                     

MARINA PEÑUELAS, FRANCISCO JAVIER CANDEL, CLARA LEJARRAGA,  LAURA LÓPEZ-GONZÁLEZ, JOSE MANUEL VIÑUELA-PRIETO, DIEGO LÓPEZ DE MENDOZA          

Introduction. The prevalence of methicillin-resistant Staphylococcus aureus (MRSA) in Spain is approximately 20-30%. However, resistance to linezolid is rare, and the main reports are from nosocomial outbreaks. The objective of the present study was to compare the in vitro susceptibility of linezolid with that of tedizolid against MRSA isolates and methicillin-and linezolid-resistant isolates (MLRSA) mediated by the cfr gene.
Material and methods. The in vitro susceptibility of linezolid and tedizolid was determined using the E-test with 18 MRSA strains and 18 cfr-mediated MLRSA strains obtained from clinical isolates in the microbiology service of a tertiary university hospital.
Results. All MRSA strains were susceptible to both antibiotics. Analysis of the MRSA isolates revealed that the MIC50 and MIC90 of linezolid were 1.5 and 2 mg/L, respectively; those of tedizolid were 0.25 and 0.4 mg/L. The MIC50 and MIC90 of tedizolid remained at 0.75 and 1 mg/L against the MLRSA strains (MIC90 ≥ 8 mg/L).
Conclusions. Both for MRSA and for MLRSA, the MICs obtained for tedizolid were at least 2 dilutions lower than those of linezolid, thus demonstrating between 2 and 4 times greater activity in vitro than linezolid.

Rev Esp Quimioter 2016; 29(5):255-258 [pdf]

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Rev Esp Quimioter 2016, 29(5):249-254

Demographic characteristics, malaria chemoprophylaxis and vaccination in 6,783 international travelers attended in a specialized unit                     

NIEVES JAÉN-SÁNCHEZ, LAURA SUÁREZ-HORMIGA, CRISTINA CARRANZA-RODRÍGUEZ, MICHELE HERNÁNDEZ-CABRERA, ELENA PISOS-ÁLAMO, LOURDES GARCÍA-REINA, JOSÉ LUIS  PÉREZ-ARELLANO          

Background. The objective of this paper was to determine the demographic characteristics and the evolution of international travelers treated at the Unit of Infectious and Tropical Medicine in order to improve precautions prior to travel and, thus reduce the occurrence of these diseases.
Methods.  A retrospective study of all international travelers served in UEIMT (Las Palmas de Gran Canaria) during the period 1998-2013 was performed. The following variables were collected using a standardized protocol were analyzed: age, gender, date of consultation, type of traveler, countries of destination and preventive measures undertaken (malaria chemoprophylaxis and vaccines).
Results. A total of 6,783 international travelers of which 52% were women were analyzed. The average age was 36 years (SD 13). The most frequent destination continent was Africa (39%) followed by Asia (36%) and Latin America (23%). The most common country of destination was India 13% (882), followed by Senegal 7.5% (509) and Thailand 6.3% (429). The most frequently recommended vaccines were typhoid fever (82.9%) and hepatitis A (66.9%). As for malaria prophylaxis, the indicated drugs were atovaquone-proguanil (56.5%), mefloquine (36.7%), in regard to travelers returning to visit relatives and friends with a 26.81% were children (0-9 years).
Conclusions. The overall profile of the traveler is a young man who chooses holiday destination Africa followed by Asia and Latin America. Over 50% of travelers received vaccination against typhoid and hepatitis A. The most commonly used malaria chemoprophylaxis was atovaquone / proguanil followed by mefloquine.

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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.

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Rev Esp Quimioter 2016, 29(5):265-268

Correlation between MALDI-TOF Vitek-MSTM system and conventional identification methods of gastrointestinal infection causing bacteria                     

CARLOS RUIZ DE ALEGRÍA-PUIG, AMAIA AGUIRRE-QUIÑONERO, JESÚS AGÜERO-BALBÍN, Mª PIA ROIZ-MESONES, LUIS MARTÍNEZ-MARTÍNEZ          

Introduction. Rapid identification of pathogens is essential for the diagnosis of gastrointestinal infections. Matrix-assisted laser desorption/ionization time of flight (MALDI-TOF) mass spectrometry has shown to be effective and fast for the identification of microorganisms. The objective of this study was to evaluate the correlation between Vitek-MSTM and conventional methods for bacterial identification causing gastrointestinal infection.
Material and methods. A total of 329 gastrointestinal pathogens were identified using Vitek-MSTM (v2 SARAMIS MS -ID, bioMérieux, Marcy-I´Étoile, France) and routine diagnostic methods simultaneously. In cases of discrepancy 16SrRNA gene sequencing was performed.
Results. The correlation between Vitek-MSTM and diagnostic methods was 100% except for Yersinia enterocolitica (94.1%), Helicobacter pylori (10%) and Aeromonas veronii (0 %).
Conclusions. Vitek-MSTM is a quick and useful method for identification of enterophatogenic bacteria. It is necessary to improve the performance of the system for the identification of H. pylori and A. veronii.

Rev Esp Quimioter 2016; 29(5):265-268 [pdf]

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Rev Esp Quimioter 2016, 29(5):273-277

Prosthetic joint infection in patients with hip fracture. Differences from infection of elective prosthesis                     

JOSÉ Mª BARBERO, EDUARDO MONTERO, ALFONSO VALLÉS, MIGUEL ÁNGEL PLASENCIA, JUAN ROMANYK, JOAQUÍN LÓPEZ          

Introduction. Most publications about prosthetic joint infections (PJI) are referred to elective prosthesis and they exclude arthroplasties due to hip fracture.
Methods. We conducted a descriptive study about prosthetic joint infections after joint fracture in Alcalá de Henares Hospital (Madrid) between 2009 and 2014 and we compared with elective prosthetic infections in the same period.
Results. There were 30 PJI after hip fracture and 14 elective PJI. The incidence of infection was 4.7% in arthroplasties due to hip fracture from 1.3% in elective prosthesis (RR 3.8, p=0.005). The PJI after fracture affected older patients (82.5 years vs 71.5, p=0.006), with greater comorbidity (5.4 vs 3.6, p=0.003), higher anesthetic risk (ASA>2 70% vs 21.4%, p=0.004) and higher incidence of dementia (50% vs 0%, p=0.02). Staphylococcus aureus was the most common causative agent in both groups, but there was higher incidence of Gram negative-cases in PJI after fracture group (43.3% vs 21.4%, p no significance) and cefazolin-resistance (63.3% vs 28.6%, p=0.03). In logistic regression analysis the treatment had less chance of success in PJI after fracture than elective PJI (33.3% vs 78.6%, OR 0.09, p=0.06).
Conclusions. The PJI after fracture are more frequent than elective PJI, affect older patients, with poor general condition, are produced by more resistant bacteria and have worst evolution than EPJI.

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Rev Esp Quimioter 2016, 29(4):230-238

2016 Expert consensus document on prevention, diagnosis and treatment of short-term peripheral venous catheter-related infections in adult                     

JOSEP A. CAPDEVILA, MARÍA GUEMBE, JOSÉ BARBERÁN, ARÍSTIDES DE ALARCÓN, EMILIO BOUZA, M. CARMEN FARIÑAS, JUAN GÁLVEZ, MIGUEL ÁNGEL GOENAGA, FRANCISCO GUTIÉRREZ, MARTHA KESTLER, PEDRO LLINARES, JOSÉ M. MIRÓ, MIGUEL MONTEJO, PATRICIA MUÑOZ, MARTA RODRÍGUEZ-CREIXEMS, DOLORES SOUSA, JOSÉ CUENCA, CARLOS-A. MESTRES ON BEHALF THE SEICAV, SEMI, SEQ AND SECTCV SOCIETIES          

The use of endovascular catheters is a routine practice in secondary and tertiary care level hospitals. Short peripheral catheters have been found to be associated with the risk of nosocomial bacteremia resulting in morbidity and mortality. Staphyloccus aureus is mostly associated with peripheral catheter insertion. This Consensus Document has been elaborated by a panel of experts of the Spanish Society of Cardiovascular Infections in cooperation with experts from the Spanish Society of Internal Medicine, Spanish Society of Chemotherapy and Spanish Society of Thoracic-Cardiovascular Surgery and aims at define and establish the norm for management of short duration peripheral vascular catheters. The document addresses the indications for insertion, catheter maintenance and registry, diagnosis and treatment of infection, indications for removal and stresses on continuous education as a driver for quality. Implementation of this norm will allow uniformity in usage thus minimizing the risk of infection and its complications.

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Rev Esp Quimioter 2016, 29(5):244-248

About microbiological methods for detection of oxacillin resistance in coagulase-negative staphylococci                     

MIGUEL FAJARDO, ROCÍO HIDALGO, JORGE GAITÁN, ROSA SÁNCHEZ-SILOS, PALOMA MARTÍN-CORDERO          

Introduction. Coagulase-negative staphylococci (CoNS) take part of the human skin and mucous membranes, but they are also involving in infections with the increasing use of prosthetic, indwelling devices or intravascular catheter-related bacteraemia. They are more resistance than Staphylococcus aureus against a wide range of antimicrobial agents, and it have been observed an increase in morbidity and mortality of patients with incorrect treatment.
Material and methods. To analyze the results obtained by different commercial techniques: two automatic microdilution systems (MicroScan and Vitek2 Compact), PBP2a agglutiation test, with and without 1 μg oxacillin disk induction, and detection of mecA gene by nucleic acids amplification techniques, for the diagnosis of methicillin resistance staphylococci in 170 strains of CoNS isolated from blood cultures.
Results. One hundred and seventy methicillin resistance staphylococci were detected by MicroScan, 167 strains by Vitek 2 Compact, 115 strains were PBP2a positive without oxacillin induction and 168 after oxacillin induction. Finally, 167 strains were mecA gene positive detected by nucleic acids amplification techniques.
Conclusions. It is necessary to do oxacillin induction before PBP2a test to avoid false negatives. There are a great variability in the phenotypic expression of methicillin resistance in CoNS.

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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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