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.

 
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Rev Esp Quimioter 2010:23(2):87-92

Comparative study of the susceptibility to daptomycin and other antimicrobials against Staphylococcus spp. resistant to methicillin and Enterococcus spp. using Wider, E-test, and microdilution methods

J. L. GÓMEZ-GARCÉS, F. LÓPEZ-FABAL, A. BURILLO, Y. GIL 

 

The human and material costs of inappropriate antimicrobial therapy are high. This study was designed to search for a rapid, simple and effective antimicrobial susceptibility test capable of identifying the best treatment strategy against microorganisms causing hospital infections showing resistance or reduced susceptibility to the more traditional antibiotics. The tests compared were the E-test, an automated test (Wider) and broth microdilution (as the reference test), to determine the susceptibility to vancomycin, teicoplanin, linezolid and daptomycin of clinical isolates of methicillin resistant Staphylococcus aureus (MRSA), methicillin resistant coagulase negative Staphylococcus spp. and Enterococccus spp. The E-test and Wider methods showed good agreement with the reference method indicating their reliability for routine susceptibility testing of staphylococci and enterococci against vancomycin, teicoplanin, linezolid and daptomycin. Notwithstanding, when faced with a serious enterococcal infection, the MIC of daptomycin should be more accurately determined using a reference technique such as broth microdilution.

 

 
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Rev Esp Quimioter 2010:23(2):93-99

Epidemiology and clinical presentation of Panton-Valentin leukocidin positive methicillin-resistant Staphylococcus aureus

N. COBOS-TRIGUEROS, C. PITART, F. MARCO, J. A. MARTÍNEZ, M. ALMELA, J. LÓPEZ, M. ORTEGA, A. SORIANO, J. MENSA 

 

Introduction: the aim of our study was to review the epidemiology and clinical manifestations of infections due to Panton-Valentine leukocidin-positive methicillin-resistant Staphylococcus aureus (PVL-MRSA).
Material and methods: Medical history of patients infected by MRSA-PVL admitted to our hospital from January 2007 to July 2009 was reviewed. PVL and the type of cromosomic cassette were determined in all strains by PCR.
Results: A total of 37 cases were included. Seventy percent were males and the median age was 39 years. Sixtytwo percent were Spanish, 14 (37.8%) were HIV-positive and 11 (29.7%) were homosexual. The source of the infection was the skin and soft tissue in 36 cases and pneumonia in 1. Sixteen patients were hospitalized, 5 had bacteremia and 5 developed septic metastasis. The relapse rate was 24% (9 cases). The prevalence during the study period was 11.2% of all MRSA isolated (37 out of 329). All the strains had a cromosomic cassette type IV and were susceptible to cotrimoxazole, rifampin, vancomyin, daptomycin and linezolid. The MIC of vancomycin, measured by E-test, was ≥1.5 mg/L in 28 out of 34 cases (82.3%).
Conclusions: Eleven percent of the MRSA strains isolated in our hospital are PVL positive. In general, skin and soft tissue infections are the most common and bacteremia or septic metastasis are frequent. In contrast to previous Spanish studies, more cases are observed in patients born in Spain and the infections are more severe.

 
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Rev Esp Quimioter 2010:23(2):103-108

A combination of tigecycline, colistin, and meropenem against multidrug-resistant Acinetobacter baumannii bacteremia in a renal transplant recipient: pharmacodynamic and microbiological aspects  

F.J. CANDEL, N. CALVO, J. HEAD, A. SÁNCHEZ, M. MATESANZ, E. CULEBRAS, A. BARRIENTOS, J. PICAZO 

 

Acinetobacter baumannii are emerging as the causal agents of healthcare-associated infections. We describe a renal transplant recipient who developed bacteremia caused by multiresistant A. baumannii, which received a combination of tigecycline, colistin, and meropenem in continuous infusion. The clinical outcome was favorable. In this article we made a molecular study of this multiresistant strain. Our analysis reveals the presence of a bla-OXA-72 gene, a class D of oxacillinase belonging to bla-OXA-40-like group, which constitutes the most disseminated familiy of carbapenemases in Spain. Thus, we found different susceptibility patterns of A. baumannii when we used different Mueller-Hinton agars with different manganese concentrations. Lastly, we explain the combination of these three antibiotics administered to increase microbiologic and pharmacodynamic yield.

 
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Rev Esp Quimioter 2010:23(3):109-114

Treatment of human infections caused by Bartonella spp. 

L. PÉREZ-MARTÍNEZ, J. R. BLANCO, J. A. OTEO 

 

Infections by Bartonella spp. include a wide spectrum of emerging and re-emerging infectious diseases.There is not a universal therapy for this infection, therefore treatment should be chosen individually. The aim of this review is to update the therapeutics aspects of this kind of infections.

 
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Rev Esp Quimioter 2010:23(3):115-121

Endotoxin adsortion as adjuvant therapy in gramnegative severe sepsis 

F.J. CANDEL, F. MARTÍNEZ-SAGASTI, M. BORGES, E. MASEDA, M. HERRERA-GUTIÉRREZ, J. GARNACHO-MONTERO, F.J. MAYNAR, R. ZARAGOZA, J. MENSA, J.R. AZANZA 

 

The mortality rate of severe sepsis and septic shock remains still high. Within the last years a better knowledge of its physiopathology and the implementation of a group of measures addressed to a fast identification and early treatment of the septic patients have proved to reduce mortality rate. Likewise, it continues being investigated in modulating the inflammatory response and limiting the harmful action of the bacterial products on the immune system. As a result of this research some endotoxin adsorber devices have been designed to control one of the most important targets that start the inflammatory cascade when gramnegative microorganisms are involved.The usefulness that these endotoxin removal devices might have as adjuvant treatment in the Septic Syndrome and its applicability are reviewed in this paper. Likewise a profile of patient that might be to the benefit of this therapy is suggested according to the current knowledge.  

 
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Rev Esp Quimioter 2010:23(3):122-125

Antifungal activity of posaconazole against Candida spp. and non-Candida clinical yeasts isolates 

A. J. CARRILLO-MUÑOZ, C. TUR-TUR, J. M. HERNÁNDEZ-MOLINA, G. QUINDÓS, C. MARCOS-ARIAS, E. ERASO, D. CÁRDENES, O. ORTIZ-MAESTRO, P. SANTOS, D. ESTIVILL, C. GUARDIA, G. GIUSIANO 

 

The in vitro antifungal activity of posaconazole was tested against 315 yeast clinical isolates and 11 ATCC reference strains by means an agar diffusion method (Neosensitabs, Rosco,Denmark) based in CLSI M44-A2 document. Posaconazole activity was excellent against Cryptococcus and Rhodotorula species studied and showed very good activity against most species of Candida tested. A total of 13 clinical isolates (4.1%) were resistant: Candida albicans (n=5), Candida glabrata (n=5), Candida tropicalis (n=1), Geotrichum australiensis (n=1) and Geotrichum capitatum (n=1). Our results suggest posaconazole is an effective antifungal agent against the most clinically important yeasts species (92.7% of susceptibility). Agar diffusion method provides good conditions for the posaconazole susceptibility study in the routine laboratory.  

 
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Rev Esp Quimioter 2010:23(3):126-134

Critical study of spanish adult consumer profile of antibiotics on the basis of National Surveys of Health in 1993, 1995, 1997, 2001 and 2003 

J. L. BAQUERO, J. BARBERÁN, D.MARTÍNEZ   

 

Objective: The objective of this study has been to examine antibiotic consumption in Spain through the use of the National Surveys of Health (NSH) .
Material and methods: Taking the NSH, between 1993 and 2003, certain variables regarding the consumption of antibiotics have been analyzed; putting these into groups according to their typology, habits, comorbidity and the utilization of health resources. This information has been compared with published data by other authors.
Results: The consumption of antibiotics was approximately 3%, and 9-19% of this was not prescribed. Significant statistical associations have been observed between the consumption of antibiotics and other aspects such as academic and income levels, habits such as smoking, general health, certain chronic diseases, being bed-ridden due to disease; and also the use of certain medicines and the anti-influenza vaccine.
Conclusions: Consumption of antibiotics coincides with described data by other authors, and this was always higher than prescribed. The association with other variables may be limited by the inadequate NSH design in order to know the exact consumption of antibiotics.   

 
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Rev Esp Quimioter 2010:23(3):135-143

Impact factor and quality of scientific publications on Microbiology: the example of the Spanish Journal of Chemotherapy 

D. CARABANTES   

 

Introduction. The impact factor of a journal is the quantitative analysis of the number of citations obtained during a specific period of time. This currently is the standard tool to measure the quality of the publication and a way to evaluate the research trajectory of a scientist.
Methods. Search for bibliometric indicators: Journal Citation Reports, SCImago Journal Rank and Potencial Impact Factor for the Spanish Medical Journals of the Instituto de Historia de la Ciencia y Documentación López Piñero (IHCD). To identify criteria of editorial quality, of visibility and of spreading by reviewing databases such as the Online Regional Information System for Scholarly Journals from Latin America, the Caribbean, Spain and Portugal (LATINDEX), SciELO (Scientific Electronic Library Online), DIALNET and the Collective Periodical Publications Catalogue of Spanish Healthcare Science Libraries, known as C17.
Results. For the first time, the Spanish Journal of Chemotherapy appears in the 2009 edition of JCR, previously by joined the two spanish journals Clinical Microbiology and Infectious Diseases and International Microbiology, both ranked at a lower position. While calculating factors of national and international impact of the five publications included in the category of Pharmacology and Pharmacy as part of theproject initiated by the IHCD, the Spanish Journal of Chemotherapy showed the best results.
Conclusions.The Spanish Journal of Chemotherapy obtained good results in analysed bibliometric indicators, positioning it at the top of the ranking of Spanish medical journals. A good spreading helped to maintain visibility on the publication in the editorial field.   

 
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Rev Esp Quimioter 2010:23(3):144-152

Comparative activity of doripenem, meropenem, and imipenem in recent clinical isolates obtained during the COMPACT-Spain epidemiological surveillance study 

C. GIMENO, R. CANTÓN, A. GARCÍA, M. GOBERNADO Y GRUPO ESPAÑOL DE ESTUDIO DE DORIPENEM   

 

Introduction. Doripenem is a new carbapenem with broad spectrum antibacterial activity indicated for the treatment of nosocomial pneumonia and complicated urinary and intraabdominal infections.
Methods. Isolates of Pseudomonas aeruginosa, Acinetobacter and Enterobacteriaceae from patients with nosocomial pneumonia, bacteremia and complicated intraabdominal infections attended in 16 Spanish hospitals were included (October 2008–May 2009). Susceptibility to imipenem, meropenem and doripenem was studied with the Etest method, and the results were interpreted according to the EUCAST criteria.
Results. Considering all the isolates, doripenem (MIC50 0.12 mg/L) was 2- to 8-fold more active than meropenem (0.25 mg/L) and imipenem (1 mg/L). In relation to Enterobacteriaceae, the MIC50 and MIC90 values of doripenem and meropenem were similar (0.03 and 0.12 mg/L, respectively) and clearly superior to those of imipenem (0.25 and 1 mg/L). In the case of P. aeruginosa, MIC50 and MIC90 were more favorable to doripenem (0.25 and 16 mg/L) than to meropenem (0.5 and ≥64 mg/L) or imipenem (2 and ≥64 mg/L). In this species, the percentage of strains with lower MIC values for doripenem among those exhibiting intermediate susceptibility and resistance to meropenem was 63.0% (29/46) and 61.7% (63/102), respectively, versus only 4.3% (2/46) and 1.9% (2/102) with higher MIC values for doripenem.
Conclusions.The results obtained in this study are similar to those reported in other countries, and reinforce the superior in vitro activity of doripenem versus the other carbapenems and its position in the treatment guidelines regarding the nosocomial infections for which it is indicated.   

 
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