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]

Rev Esp Quimioter 2016, 29(6):308-317

Darunavir/cobicistat monotherapy. Experience in a tertiary hospital                     

LUCIA YUNQUERA-ROMERO, ROCÍO ASENSI-DÍEZ, JUAN CARLOS DEL RIO-VALENCIA, ISABEL MUÑOZ-CASTILLO, MANUEL ÁNGEL CASTAÑO-CARRACEDO          

Introduction. Ritonavir-boosted protease inhibitor (IP/r) monotherapy: darunavir/ritonavir (DRV/r) or lopinavir/ritonavir (LPV/r) monotherapy is only provided in the major treatment guidelines in pretreated patients to prevent toxicity associated with nucleoside/nucleotide reverse transcriptase inhibitor (NRTI), reduce costs and simplify antiretroviral treatment. To start IP/r monotherapy, according to GESIDA guidelines 2016, patients need to meet the following criteria: absence of chronic hepatitis B, plasma viral load <50 copies/ mL for at least 6 months and absence of protease inhibitors mutations or previous virologic failures to IP/r. Currently, there are no studies that evaluate the efficacy and safety of darunavir/cobicistat (DRV/COBI) monotherapy.
Methods. This prospective study analyzed pretreated HIV patients with DRV/r monotherapy that were switched to DRV/COBI monotherapy. The aim of the study is to describe the effectiveness and safety of the DRV/COBI monotherapy.
Results. Seventy-eight patients were evaluated. Patients had a median of 31.29 months of DRV/r monotherapy before DRV/COBI monotherapy. Nine of the 78 patients developed “blips” (plasma viral load: 50-200 copies/ml) and four patients had plasma viral load ≥200 copies/mL. An 83.3% (65/78) of the patients remained with undetectable plasma viral load. As for safety, there were no significant differences in lipid profile, liver function (transaminases) and renal function between DRV/r and DRV/COBI monotherapy.
Conclusions. DRV/COBI monotherapy seems to be effective and safe (lipid profile, liver and kidney function). However, it will be necessary to design specific studies comparing DRV/r vs DRV/COBI monotherapy to confirm these results.

Rev Esp Quimioter 2016; 29(6):308-317  [pdf]

Rev Esp Quimioter 2016, 29(6):318-327

Key issues in the infected patient care in the Emergency Department                     

FLAVIA CHIARELLA, JUAN GONZÁLEZ-DEL CASTILLO, FRANCISCO JAVIER CANDEL, ERIC JORGE GARCÍA- LAMBERECHTS, MARÍA JOSÉ NÚÑEZ-ORANTOS, FRANCISCO JAVIER MARTÍN-SÁNCHEZ REPRESENTING THE INFECTIOUS DISEASE GROUP OF SPANISH EMERGENCY MEDICINE SOCIETY          

Objective. To develop a set of recommendations, by consensus of Emergency Medicine experts, on key aspects related to the care of adult patients with acute infection attended in Spanish emergency departments (ED).    
Methodology. The study was divided into three phases: 1) To design a questionnaire by a coordinating group; 2) To conduct a survey in ED physicians in order to know their opinion on the issues raised by the coordinating group; 3) To develop a number of recommendations based on the responses to the questionnaire and their subsequent discussion.
Results. A group of 28 experts from different Spanish ED, as well as 5 members of the coordinating group, with knowledge and experience in the management of infectious diseases in ED, conducted a round of voting to a questionnaire of 18 issues grouped into three sections: 1) identification and stratification of the severity; 2) diagnosis and treatment; 3) management.   
Conclusions. A monitoring system and proper training of the entire healthcare team are required, as well as extensive knowledge on these issues, to ensure adequate and effective care for these patients. It is essential to educate and train all health staff, especially in the ED, because it is the initial point of contact for most patients with an infection. The experts established proposals based on survey questions and the discussion.

Rev Esp Quimioter 2016; 29(6):318-327 [pdf]

Rev Esp Quimioter 2016, 29(6):288-295

Determinants of parasite drug resistance in human lymphatic filariasis                     

FERNANDO COBO           

Infection with filarial nematodes remains endemic in several countries worldwide and some of these infections are commonly associated with severe disease. The elimination of lymphatic filariasis relies on drug administration using the three drugs currently available for treatment: diethylcarbamazine, albendazole, and ivermectin. However, development of drug resistance is a reported phenomenon. The issue of resistance to antihelminthics used in humans has become increasing importance since the global program to eliminate lymphatic filariasis is implemented in larger population groups and the duration of the program is increasing. Recently, ivermectin resistance has been reported in Ghana, and widespread of resistance to benzimidazole (such as albendazole) is present because specific mutations in the gene encoding β-tubulin have been associated with drug resistance. Moreover, it is well known that diethylcarbamazine susceptibility is not 100% for lymphatic filariasis treatment. A review of the mechanisms of resistance to these antihelminthics is necessary in order to optimize the treatment for human lymphatic filariasis.

Rev Esp Quimioter 2016; 29(6):288-295  [pdf]

Rev Esp Quimioter 2017, 30(1):34-39

Is it necessary to prescribe antibiotics in impacted third molar surgical removal?: comparative study between prescribing patterns                     

ISABEL IZUZQUIZA, KENT ARE JAMTØY, NILS PETTER FOSSLAND, IRENE MARTÍNEZ-PADILLA, FARZIN FALAHAT, LUIS ALOU, JOSÉ PRIETO, MARÍA LUISA GÓMEZ-LUSO           

Objective. To assess whether there is a significant difference in infection rate after surgery tooth extraction in two different hospitals from Norway and Spain where different surgical antimicrobial prophylaxis protocols are applied.
Methods. An analytical observational study was conducted, retrospective cohorts type, analyzing healthy patients with no risk factors, who were third molar tooth operated in maxillofacial services of two different hospitals: St. Olav in Trondheim (Norway) and Clínico San Carlos in Madrid (Spain). The collected variables were: age, number of tooth removed, anesthesia type, and observations about the course of the operation registered in the clinical history. To assess the development of postoperative infection, patient’s data of those who chose the hospital as the place to remove the suture thread were collected in Norway, whereas in Spain a telephone survey was conducted to determine the course of the operation months later.
Results. In St. Olav Hospital 11.1% of patients operated received antibiotic regimen after surgery, while in Hospital San Carlos were 100%. The infection rate was 15% in St.Olav Hospital and 7.5% in Hospital San Carlos. These differences were no statistically significant.
Conclusions. The routine administration of antibiotics to healthy patients with no risk factors undergoing impacted third molar surgical removal is a common clinical practice which it does not seem to be justified.

Rev Esp Quimioter 2017; 30(1):34-39  [pdf]

Rev Esp Quimioter 2017; 30(1):9-13

Time-to-positivity, type of culture media and oxidase test performed on positive blood culture vials to predict Pseudomonas aeruginosa in patients with Gram-negative bacilli bacteraemia                     

NAZARET COBOS-TRIGUEROS, YULIYA ZBOROMYRSKA, LAURA MORATA, IZASKUN ALEJO, CRISTINA DE LA CALLE, ANDREA VERGARA, CELIA CARDOZO, MARIA P. ARCAS, ALEX SORIANO, FRANCESC MARCO, JOSEP MENSA, MANEL ALMELA, JOSE A. MARTINEZ           

Introduction. The aim of this study was to determine the usefulness of oxidase test and time-to-positivity (TTP) in aerobic and anaerobic blood culture vials to detect the presence of Pseudomonas aeruginosa in patients with Gram-negative bacilli (GNB) bacteraemia.
Material and methods. TTP was recorded for each aerobic and anaerobic blood culture vial of monomicrobial bacteraemia due to GNB. Oxidase test was performed in a pellet of the centrifuged content of the positive blood culture. An algorithm was developed in order to perform the oxidase test efficiently taking into account TTP and type of vial.
Results. A total of 341 episodes of GNB bacteraemia were analysed. Sensitivity, specificity, positive predictive value and negative predictive value of the oxidase test performed on positive vials with GNB to predict P. aeruginosa were 95%, 99%, 91%, and 99%, respectively.  When growth was first or exclusively detected in anaerobic vials, P. aeruginosa was never identified hence the performance of the oxidase test could be avoided. When growth was only or first detected in aerobic vials, a TTP≥8h predicted P. aeruginosa in 37% or cases (63 of 169), therefore oxidase test is highly recommended.
Conclusions. Oxidase test performed onto positive blood culture vials previously selected by TTP and type of vials is an easy and inexpensive way to predict P. aeruginosa. In most cases, this can lead to optimization of treatment in less than 24 hours.

Rev Esp Quimioter 2017; 30(1):9-13  [pdf]

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]

Rev Esp Quimioter 2017; 30(1):19-27

Design and implementation of an outpatient parenteral antimicrobial therapy program in primary care: the experience at a second level hospital                     

MARÍA RUIZ-CAMPUZANO, ELISA GARCÍA-VÁZQUEZ, JOSÉ JOAQUÍN HERNÁNDEZ-ROCA, JOAQUÍN GÓMEZ-GÓMEZ, MANUEL CANTERAS-JORDANA, ENRIQUE MENÉ-FENOR, ALICIA HERNÁNDEZ-TORRES, ANA PELÁEZ-BALLESTA           

Introduction. Outpatient parenteral antimicrobial therapy (OPAT) programs are a good assistance option in a wide variety of infectious diseases. Our aim was to design and implement an OPAT program in the area of influence of a second-level hospital, with no Home Hospitalization Service available, being necessary close collaboration between hospitalization and Primary Care teams, describe our cohort, analyse the antimicrobial treatment indicated and evaluate the prognostic and risk factors associated with readmission and mortality. 
Material and methods. Prospective study cohorts of patients admitted to the OPAT programme, from 1 January 2012 to 31 May 2015.
Results. During the period of study a total of 98 episodes were recorded. The average age of the cohort was 66 years. The most frequent comorbidity was immunosuppression (33.67 %), with an overall average of Charlson index of 5.21 ± 3.09. The most common source of infection was respiratory (33.67 %). Microbiological isolation was achieved in fifty-eight patients (59.18 %) being Escherichia coli the most frequently isolated (25%). The average number of days of antibiotics administration at home was 10.42 ± 6.02 (SD), being carbapenems (43.48%) the more administered. Eighty-six patients (87.75%) completed the treatment successfully. Thirty-two patients (32.65%) were readmitted within 30 days after being discharged and seven patients (7.14%) died. A statistically significant association was only found in the readmission with variables: elderly patients (p=0.03), being carriers of Porth-a-Cath (p=0.04) and treatment termination related with infection (p<0.05).
Conclusions. This is the first programme of OPAT administration not dependent on Home Hospitalization Service in Spain, which could allow to optimize the hospital and primary care resources available. Nevertheless this pilot study results are poor in terms of optimization of antibiotics choice, transition to oral administration, de-escalation and duration.

Rev Esp Quimioter 2017; 30(1):19-27  [pdf]

Rev Esp Quimioter 2017; 30(1):1-8

Fluoroquinolones: Non-antibacterial properties                     

SOCORRO LEYVA-RAMOS, HIRAM HERNÁNDEZ-LÓPEZ           

Fluoroquinolones are a class of well-established chemotherapeutic agents with a potent biological activity being the structure of 4-quinolone-3-carboxilic acids privileged because it contains different sites for functionalization allowing expand its use in clinical practice for their antifungal, antiviral and anticancer activities. Quinolones structural changes have resulted in a first, second, third and fourth generation of drugs so it is advisable to continue modifying existing structures in new ways to generate compounds with desirable  biological and pharmacological properties.

Rev Esp Quimioter 2017; 30(1):1-8 [pdf]

Rev Esp Quimioter 2017; 30(1):40-44

Comparative study of HIV-1/2 antibody confirmatory assay: Geenius™ versus INNO-LIA™                    

AITZIBER AGUINAGA ANA NAVASCUÉS ISABEL POLO CARMEN EZPELETA           

Introduction. The aim of the study is to compare two confirmatory tests for HIV-1/2 infection.
Material and methods. A prospective study was carried out between 01/01/2015 and 12/31/2015. Serum samples with repeatedly positive results in the Antibody-Antigen-HIV-1/2 (Architect, Abbott) screening assay were included. The serum samples corresponding to new diagnosed cases were selected and were used to compare the two confirmatory assays: Geenius™ HIV-1/2 (Bio-Rad) and INNO-LIA™ HIV-1/2 score line-immunoassay (Innogene-tics®). The HIV-1 viral load (Cobas® AmpliPrepHIV, Ro-che) was performed in discordant or indeterminate cases.
Results. Eight five samples were included. The results of both confirmatory assays were concordant in 80/85 samples: 53 HIV-1, 1 HIV-2, 25 negative and one indeterminate. Cohen’s Kappa concordance coefficient between Geenius™ and INNO-LIA™ techniques was very high (0.878).
Conclusion. The concordance between the two assays is high. The procedure for Geenius™ is simple and fast. Geenius™ is a good alternative to include in the HIV-1/2 diagnostic algorithm.

Rev Esp Quimioter 2017; 30(1):40-44  [pdf]