Rev Esp Quimioter 2011:24(4):209-211

Burkholderia cepacia bacteremia: a prospective analysis of 33 episodes          


M. IBARGUREN, N. COBOS-TRIGUEROS, Á. SORIANO, J. A. MARTÍNEZ, Y. ZBOROMYRSKA, M. ALMELA, J. MENSA              

Introduction: The aim of this study is to describe clinical characteristics and outcome of Burkholderia cepacia bacteraemia, susceptibility of the isolates and differences between cases from epidemic outbreaks and sporadic cases.
Material and methods: From 1993 to 2009, episodes of B. cepacia bacteraemia were prospectively collected in a university hospital.
Results: A total of 33 episodes were included, of which 21 were part of two outbreaks (9 in 1994 and 12 in 2006). Outbreak cases had a median age of 58 years, 45% had neoplasia, median length of stay until bacteraemia was 15 d (range 0-120) and 82% had received an antibiotic. The most prevalent sources of bacteraemia were catheter (48%) and unknown (33%). On the other hand, sporadic cases stayed longer until diagnosis (median 25 days versus 11, p=0.041) and showed a trend to have neoplasia more frequently (83% versus 33%, p=0.083). Susceptibility to antibiotics was varied and co-trimoxazole was the only active agent against all strains.
Conclusions: B. cepacia is an uncommon pathogen, which affects patients with prolonged hospitalization and severe comorbidities. The identification of more than one case in a short term of time should raise the suspicion of an outbreak. 

 
Rev Esp Quimioter 2011:24(4):209-211 [pdf]

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Rev Esp Quimioter 2012:25(1):79-88


Prevention of perinatal group B Streptococcal disease. Updated Spanish recommendations 
                

J. I. ALÓS, A. ANDREU, L. ARRIBAS, L. CABERO, M. CUETO, J. LÓPEZ, J. C. MELCHOR, A. PUERTAS, M. DE LA ROSA, S. SALCEDO, M. SÁNCHEZ, M. J. SÁNCHEZ, R. TORREJÓN                                                          

It has been a significant reduction in neonatal group B streptococcus (GBS) infection in Spain following the widespread application of intrapartum antibiotic prophylaxis. In 2010, new recommendations have been published by the CDC and this fact, together with the new knowledge and experience available, has driven to the participating scientific societies publishing these new recommendations. In these recommendations is advised to study all pregnant women at 35-37 gestation weeks` to determine if they are colonized by GBS and to administer intrapartum antibiotic prophylaxis (IAP) to all colonized mothers. Microbiological methods to identify pregnant GBS carriers are updated and intrapartrum antibiotic prophylaxis in preterm labour and premature rupture of membranes and the management of the newborn in relation to GBS carrier status of the mother are also revised.
  

Rev Esp Quimioter 2012:25(1):79-88 [pdf]

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Rev Esp Quimioter 2012:25(3):226-239

Consensus Document on vaccination against influenza in health care workers                   

J. J. PICAZO, L. M. ALONSO, J. ARÍSTEGUI, J. M. BAYAS, J. SANZ, P.  DEL AMO, J. L. COBOS, J. RODRÍGUEZ-SALAZAR, M. SÁNCHEZ-PASTOR, R. DE LA CÁMARA, J. CARRATALÁ, J. L. CAÑADA, J. GONZÁLEZ-DEL CASTILLO, P. ALDAZ, F. PÉREZ-ESCANILLA, J. BARBERÁN, A. RODRÍGUEZ, D. VIGIL-ESCRIBANO, J. ESPINOSA-ARRANZ, J. BLANQUER, F. GONZÁLEZ-ROMO                                                                          

 
Health care workers (HCW) are included each year among risk groups for vaccination against influenza. However, vaccination coverage among this group in our country is very low, not exceeding 25%. Convinced that one of the best tools to increase this coverage among professionals in our country are the scientific evidence, 19 scientific societies and associations professionals bringing together health professionals more directly related to influenza as an health problem, and the General Nursing Council, met to discuss and develop this consensus document in order to inform HCW about the appropriateness of their vaccination against influenza and the benefits that flow from it for themselves, for their patients and for the rest of the population. This recommendation is based on 3 pillars: argument of necessity, ethics and exemplary.

 

Rev Esp Quimioter 2012:25(3):226-239 [pdf]

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Rev Esp Quimioter 2010:23(2):76-80

Variability in the sensitivity to tigecycline against Acinetobacter baumannii in different culture medium

A. TENORIO-ABREU, J. M. EIROS, E. RODRÍGUEZ-MOLINS, D. ANDALUZ, F. BOBILLO, M. DOMÍNGUEZ-GIL, R. ORTIZ DE LEJARAZU 

 

Introduction. The tigecycline may represent a therapeutic alternative for the control of multiresistant A. baumannii, although there is no consensus regarding the cutoff points for sensitivity or variability of MIC as a function of culture medium used for the antibiogram against this microorganism. Therefore, our objective was to verify this variability, and propose the culture medium that comes closest to the standard method.
Methods. We selected 41 strains of carbapenem-resistant A. baumannii. We analyzed the sensitivity to tigecycline in different culture medium: Mueller Hinton agar Oxoid commercial (C-MH), Mueller Hinton fresh agar BD and Co., USA (F-MH) and ISO-sensitest fresh agar Oxoid, using the E-test and disk. The MICs were compared against those obtained using the technique standard of macrodilution.
Results. The mean MIC and inhibition diameters obtained in the different culture medium corresponded to 9.26 mg/L and 15.1 mm in diameter for MH-C, 1.71 mg/L and 22.7 mm for MH-F; 2.68 mg/L and 20.8 mm for ISO-sensitest. Half the MIC obtained by the standard method of dilution was 0.47 mg/L (SD = 0.21), with values between 0.25 and 1 mg/L.
Conclusion. In the three growth media studied, MICs superior to the standard are observed, which is false to interpret resistance in many cases. However, the medium that comes closer more that of reference is the MH-F.

 
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Rev Esp Quimioter 2010:23(4):196-200

Antibiotic susceptibility of Corynebacterium macginleyi strains causing conjunctivitis   

M. ESPÍNOLA, Á. SOMODEVILLA, D. DOMINGO, T. ALARCÓN, M. LÓPEZ-BREA    

 

Introduction. Lipophilic corynebacteria are part of the saprophytic skin flora and they rarely cause infection. C.macginleyi is an exception since it has been involved in conjunctivitis and other ocular surface affections.

Material and methods. Thirty three C. macginleyi strainswere obtained from conjunctival swabs from patients with conjunctivitis symptoms. The minimum inhibitoryconcentration (MIC) for 7 antibiotics (penicillin, gentamycin,ciprofloxacin, tetracycline, vancomycin, rifampicin and linezolid) was tested by broth microdilution method.

Results. One strain was resistant to ciprofloxacin (MIC=16 mg/L) and two were resistant to tetracycline (MIC= 64 y 16mg/L). The rest of the strains were susceptible to all the antibiotics tested.

Conclusions. At the moment, C. macginleyi does not present a major problem due to the low resistance rates shown in the present and other studies. However, epidemiological surveillance of its susceptibility pattern is needed as well as an appropriate use of topical antibiotics in order to achieve a good infection control.    

 
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Rev Esp Quimioter 2011:24(2):99-106

Consumption of antibiotics of the general population of Segovia area during the period between 1999 to 2007    

J. M. PINILLA, J. M. EIROS, F. ARAHUETES, S. VEGA, E. MORENO          

 

Introduction. The antibiotics are the medicaments most used after the analgesics, being prescribed more than 85 % in Primary Care. The aim of the study is to analyze the evolution of the prescription of antibiotics of systemic use in the general population of the Area of Segovia, during the years 1999-2007 and to know his trends evolution.
Material and methods. Antibiotics prescribed to the general population on the part of the Family physicians were processed using the information system of drugstore “CONCYLIA” that supplies the information in the shape of defined daily dose (DDD), transformed later into the indicator DHD (DDD for 1.000 inhabitants per day) taking as a base the population information of sanitary card.
Results. The global prescription of antibiotics of systemic use was high, 18,06 DHD (IC:17,22-18,90), with a variable evolution along the study in the shape of basin of low concavity. The percentage of prescription of penicillins was 64.42 % of the total of prescriptions corresponding to the group J01.
Conclusions. The prescription in the Area of Segovia has presented a contained consumption in relation to other studies, showing differences in the volume of prescription from each the subgroups. The centralization of the consumption emphasizes in the subgroup of penicillins that supposed almost two third parts of the prescribed DDD. A change in the habits of prescription is observed detailing a decrease of the amoxicillin use and an increase of amoxicillin-clavulanic acid. 

 
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Rev Esp Quimioter 2011:24(4):213-216

Antimicrobial sensitivity of hippurate-negative Campylobacter and Helicobacter pullorum strains isolated from patients with diarrhea          


P. BASCUÑANA, I. PENA, J. J. PICAZO, A. C. VELASCO                

C. jejuni as well as some hippurate-negative Campylobacter species and related diarrheagenic organisms, are the leading cause of gastroenteritis in our environment all throughout the year. The aim of the present study was to determine the sensitivity of hippurate-negative Campylobacter and Helicobacter pullorum strains isolated from the stools of patients with diarrhea. We tested 39 Campylobacter coli, two C. lari and five Helicobacter pullorum strains identified by mass spectrometry analysis. The sensitivity to amoxicillin-clavulanic acid, erytrhomycin, azithromycin, gentamicin, ciprofloxacin, levofloxacin, tetracycline, tigecycline and chloramphenicol was tested by E-test. Most hippurate-negative Campylobacter and H. pullorum isolates studied showed high resistance to tetracycline and to the two fluorquinolones tested. On the other side, all strains were sensitive to amoxicillin-clavulanic acid, tigecycline and chloramphenicol, while most of them were sensitive to both macrolides tested and to gentamicin. 

 
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Rev Esp Quimioter 2012:25(2):89-99


Emergence of plasmid mediated AmpC β-lactamasas: Origin, importance, detection and therapeutical options 
                 
C. SERAL, M. J GUDE, F. J. CASTILLO                                                            

 
AmpC β-lactamases can hydrolyze penicillins, oxyimino-, 7-α-methoxycephalosporins and monobactams. Susceptibility to cefepime or cefpirome is little affected and is unchanged for carbapenems. Originally such genes are thought to have been mobilized to mobile genetic elements from the chromosomal ampC genes from members of Enterobacteriaceae facilitating their spread and now they can appear in bacterial lacking or poorly expressing a chromosomal ampC gene. The prevalence of infection by plasmid mediated AmpC (pAmpC) varies depending on the type of enzyme and geographical location and blaCMY-2 is the most frequently detected worldwide. Typically, pAmpC producing isolates are associated with resistance to multiple antibiotics making the selection of an effective antibiotic difficult. Phenotypic and molecular methods to detect pAmpC are described and the role of different antibiotics in the treatment of these infections is examined. Surveillance studies about the evolution of this emerging resistant mechanism are important in clinical isolates. Evaluate the in vitro susceptibility of these isolates and the clinical efficacy of other therapeutic options is required.
   

Rev Esp Quimioter 2012:25(2):89-99 [pdf]

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Rev Esp Quimioter 2012:25(4):240-244

Echinocandins: searching for differences. The example of their use in patients requiring continuous renal replacement therapy                   

N. DE LA LLAMA-CELIS, R. HUARTE-LACUNZA, C. GÓMEZ-BARAZA, I CAÑAMARES-ORBIS, M. SEBASTIÁN- ALDEANUEVA, R. ARRIETA-NAVARRO                                                                            

The echinocandins have a growing role in the treatment of fungal infections because of their novel mechanism of action. This is reflected in recently published management guidelines, but available in vitro data, animal studies, and clinical studies do not clearly differentiate the three agents in class. Comparative clinical efficacy among agents within the class, pharmacokinetic profiles in special populations, pharmacoeconomics justifications, and place in therapy have been largely unanswered. They share many common properties but marketing strategies of drug manufacturers are engaged in product differentiation. Although exist similarities in the pharmacokinetic (PK) profiles of the echinocandins, limited data have been published regarding their pharmacokinetics in continuous renal replacement therapy (CRRT) patients. The pharmacokinetics of drug removal in critically ill patients receiving CRRT is very complex, with multiple variables affecting clearance. This review outlines the basic principles that determine whether a dose adjustment is required. Two studies with data on PK parameters of micafungin and anidulafungin in CRRT patients have been published and are compared following that basic principles in the review.

 

Rev Esp Quimioter 2012:25(4):240-244 [pdf]

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Rev Esp Quimioter 2010:23(2):81-86

Activity of daptomycin, ciprofloxacin, clindamycin and cotrimoxazole against coagulase-negative Staphylococcus strains with diminished susceptibility to vancomycin

M. FAJARDO, R. HIDALGO, S. RODRÍGUEZ, E. GARDUNO, F. F. RODRÍGUEZ, M. ROBLES 

 

Introduction. Coagulase Negative Staphylococci (CNS) have become one of the most common nosocomial pathogens and it has a high mortality rate due to the increased of seriously ill patients survival, long states immunosuppression and presence of foreign bodies, such as catheters, prostheses, pacemakers, etc. In addition, there is a significant increase in resistance to antimicrobial drugs, especially beta-lactams, and the increase in the MIC for vancomycin leads to a loss of clinical efficacy. This necessitates the search for new therapeutic alternatives, such as daptomycin. The aim of this paper is to study the activity of daptomycin, ciprofloxacin, clindamycin and cotrimoxazole in two groups of clinically significant CNS. a MIC90 with vancomycin ≤ 1 mg/L and the other with MIC90 2 mg/L.
Methods. We identified and studied MIC90 to ciprofloxacin, clindamycin and cotrimoxazole from 54 strains of clinically significant by the CNS Combo 22 Microscan panels (Dade Behring, Siemens). The MIC90 for daptomycin was performed using Etest (AB BioMérieux, Solna, Sweden) on Mueller Hinton plates (BioMérieux, France).

Results. In Group I (vancomycin MIC90 ≤ 1 mg/L) were 19 strains whereas in Group II (vancomycin MIC90 = 2 mg/L) were 35 strains. Expressed in mg/L, MIC90 ranges for daptomycin were 0.047-0.5 in Group I and 0.064-0.5 in Group II. For ciprofloxacin were 8 sensitive strains and 11 resistant in Group I and 10 sensitive and 25 resistant in Group II. For clindamycin were 7 sensitive strains and 12 resistant in Group I and 16 sensitive and 19 resistant in Group II. Finally, for cotrimoxazole were 10 sensitive strains and 9 resistant in Group I and 19 sensitive and 16 resistant in Group II.
Conclusions. The MIC levels to daptomycin were not influenced by the increase in the MIC for vancomycin. There was no statistically significant difference for the sensitivity of ciprofloxacin between the two groups of vancomycin. Regardless of vancomycin, there were a clear relationship between the sensitivity of ciprofloxacin with clindamycin and cotrimoxazole.

 
Rev Esp Quimioter 2010:23(2):81-86 [pdf]

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