Rev Esp Quimioter 2012:25(4):299-304

Antifungal prophylaxis in the haematological patient: a practical approach                     

L. VÁZQUEZ, E. CARRERAS, D. SERRANO, I. JARQUE, J. MENSA, J. BARBERÁN                                                                                   


Antifungal prophylaxis in the haematological patient is currently regarded as the gold standard in situations with a high risk of infection, such as acute leukaemias, myelodysplastic syndromes and autologous or allogenic hematopoietic stem cell transplantation. Over the years, different scientific societies have established a series of recommendations on antifungal prophylaxis based on prospective studies performed with different drugs. However, the prescription of each one of the agents must be personalised, adapted to the characteristics of each patient and to possible interactions with concomitant medication.  

 

Rev Esp Quimioter 2012:25(4):299-304 [pdf]

 

 

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Rev Esp Quimioter 2010:23(1):27-35

Linezolid more efficacious than vancomycin to eradicate infecting organism in critically ill patients with Gram-positive infections

J. M. SIRVENT, L. PIÑEIRO, M. DE LA TORRE, M. MOTJÉ, J. DE BATLLE, A. BONET

 

Objetive: A prospective and observational study has been conducted to analyze the efficacious of linezolid compared to vancomycin to eradicate the infecting organism in critically ill patients with Gram-positive infections.
Patients and Methods: Prospective, observational and non-controlled study in a medical-surgical intensive care unit (ICU) in a university hospital. A total number of 53 critically ill patients with therapy to proven Grampositive bacterial infection were studied. Infected patients were diagnosed and treated according to international guidelines, following standard protocol for the critically ill infected patients. Microbiologic eradication of the infecting organism at the seventh day of treatment and patients’ clinical outcome were analysed.
Results: Twenty-seventh patients received linezolid and twenty-six received vancomycin. Infection-site diagnoses were: hospital-acquired pneumonia (21 cases: 39.6%), complicated surgical-site infection (19 cases: 35.8%) and catheter-related bacteraemia (13 cases: 24.5%).The most important isolated microorganism was methicillin-resistant Staphylococcus aureus (MRSA) (28 cases:52.8%). Clinical success was 20/27 (74.1%) in the linezolid group and 16/26 (61.5 %) in the vancomycin group, with p= 0.3. The adjusted logistic regression model demonstrated that the treatment with linezolid is associated to microbiologic eradication of the infecting organism at the seventh day of treatment [OR = 7.88 (95% CI 1.86-33.52)] and p = 0.005. In this model, the length of hospital stay was lower in the group with microbiologic eradication at the seventh day (p = 0.015). Drug-related adverse events were comparable in both groups of treatment.
Conclusion: Treatment with linezolid in critically ill patients with Gram-positive infections was equivalent to vancomycin in terms of efficacy and safety, but linezolid was associated to a higher rate of microbiologic eradication of the infecting organism at the seventh day of treatment.

 
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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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Rev Esp Quimioter 2011:24(2):67-73

Pharmaecology  

J. GONZÁLEZ, A. ORERO, V. OLMO, D. MARTÍNEZ, J. PRIETO, J. A. BAHLSEN,  F. ZARAGOZÁ,  J. HONORATO       

 

Two of the main characteristics of western societies in the last fifty years have been the medicalization of the human life and the environmental degradation. The first one has forced human being to consider medicines use related to what would be rational, reasonable and well-reasoned. The second one brought us to a new ecologist conscience.
In relation to the “human social system”, the effects of medication can be considered very positive as a whole, particularly those related to the amazing increase of expectative and quality of life. But, along with those unquestionable beneficial effects, medicines have also caused some negative effects for other biotic and abiotic systems, such as microbian alterations and their undesirable consequences which have involved the massive use of antibiotics in medicine and veterinary, the uncontrolled elimination of millions of doses of all kind of drugs, additives and excipients, etc., as well as atmospheric contamination and degradation of forests and deep oceans which can have been caused by investigation and production of determinated drugs. In this context pharmaecology appears as a scientific discipline that studies the research (R), development (D), production (P), and utilization (U) of drugs and medical substances in relation to the environment. From a farmaecologic perspective the drugs utilization has its development in three main contexts, all of them closely related: prescription quality, farmaceutical care, and patient’s active participation in his own disease and treatment. 

 
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Rev Esp Quimioter 2011:24(4):175-183

Antimycobacterial natural products – an opportunity for the Colombian biodiversity       


J. BUENO, E. D. COY, E. STASHENKO            

It is estimated that one-third part of the world population is infected with the tubercle bacillus. While only a small percentage of infected individuals will develop clinical tuberculosis, each year there are approximately eight million new cases and two million deaths. Mycobacterium tuberculosis is thus responsible for more human mortality than any other single microbial species. The goals of tuberculosis control are focused to cure active disease, prevent relapse, reduce transmission and avert the emergence of drug-resistance. For over 50 years, natural products have served us well on combating infectious bacteria and fungi. During the 20th century, microbial and plant secondary metabolites have helped to double our life span, reduced pain and suffering, and revolutionized medicine. Colombia is a megadiverse country with enormous potential to offer leads for new antimycobacterial drugs. The principal aim of this article is to show a state of the art on antimycobacterial natural products research in Colombia compared to the rest of the world, in order to develop programs for bioprospecting with a view to determining the biological activity for pharmaceutical and industrial application of natural products in our country. 

 
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Rev Esp Quimioter 2012:25(1):37-41

Antimicrobial resistance in clinical patterns of Pseudomonas aeruginosa                

M. M. CASAL, M. CAUSSE, F. RODRÍGUEZ-LÓPEZ, M. CASAL                              

 

Pseudomonas aeruginosa is an opportunistic microorganism that is frequently the cause of nosocomial infections. Multiple mechanisms are involved in its natural and acquired resistance to many of the antimicrobial agents commonly used in clinical practice. We performed an antibiotic resistance study on P. aeruginosa isolated from intrahospitalary and extrahospitalary samples between 2005 and 2010 years. We included in the study a global amount of 3,029 P. aeruginosa isolates from clinical samples received at University Hospital Reina Sofia. Microbiology Service in Córdoba (Spain). Semiautomatic system WIDER I for strains identification and sensibility testing was employed. We considered susceptibility and resistance criteria recommended by MENSURA group. Results of the analysis showed that P. aeruginosa maintanied similar levels of antimicrobial susceptibility during the period 2005-2010, with increased susceptibility to amikacin, gentamicin and cefalosporins. Therewere also important differences in the degree of susceptibility between intrahospital and extrahospital strains during 2010 year, except for tobramicin and fosfomycin. The intrahospital difference in susceptibility was also evaluated, emphasizing the importance of periodically surveillance of susceptibility and resistance patterns of P. aeruginosa, in each setting in order to evaluate different therapeutic guidelines, because it is not always advisable to extrapolate data from different
regions. 

 
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Rev Esp Quimioter 2012:25(3):183-188

Antimicrobial resistance of the most frequently isolated microorganisms in the Hospital General La Mancha Centro between June 2009 and May 2010                 

M. A. ASENCIO, R. CARRANZA, M. HUERTAS                                                                           

 
Introduction: During the last two decades an increased incidence of infections caused by multiresistant bacteria has been observed. The spread of these microorganisms in the hospital is a major therapeutic and epidemiological problem. The aim of this study was to determine local resistance patterns of microorganisms causative of multirresistant infections in patients admitted to our hospital.
Methods: A retrospective study was designed, including Staphylococcus aureus, Escherichia coli, Klebsiella pneumoniae, Pseudomonas aeruginosa and Acinetobacter baumannii strains isolated from clinical and surveillance samples of patients admitted to the Hospital General La Mancha Centro, between June 2009 and May 2010.
Results: The rate of S. aureus isolates resistant to oxacillin was 50%, with 0% resistance to vancomycin. The percentage of resistance to 3rd generation cephalosporins in E. coli and K. pneumoniae was 17 and 19%, respectively; the ESBL-production in enterobacterial strains was 15 and 19%, respectively, and the quinolone resistance was 41 and 28%, respectively. The resistance of P. aeruginosa to ceftazidime and imipenem was 30 and 40%, respectively. Most strains of A. baumannii studied came from a single multidrug-resistant clone, endemic in the ICU of our hospital.
Conclusions: Of particular concern is the high rate of MRSA, E. coli and K. pneumoniae ESBL producers and resistant to fluoroquinolones as well as P. aeruginosa multiresistant. A. baumannii isolates belong mainly to endemic multidrug-resistant clone from the ICU.

 

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Rev Esp Quimioter 2010:23(1):36-42

Changes in the antimicrobial susceptibility of Escherichia coli isolates from community diagnosed urinary tract infections during the period 2003-2007. Multicentre study in Castilla la Mancha (Spain)

D. TENA, A. GONZÁLEZ-PRAETORIUS, J. C. GONZÁLEZ, E. HEREDERO, S. ILLESCAS, C. SAINZ DE BARANDA, G. SESEÑA

 

Objective: To know the evolution of susceptibility patterns of Escherichia coli in patients with communitydiagnosed urinary tract infections (UTIs) during last years in Castilla la Mancha (Spain).
Methods: Descriptive and retrospective study performed between january 2003 and december 2007. We studied data about frequency and susceptibility of 33.651 E. coli isolates from urine cultures that were remited from primary care centres depending of 6 hospitals in Castilla la Mancha (Spain).
Results: Susceptibility rates of E. coli for most antibiotics decreased significantly during the 5-year period, especially for amoxicillin-clavulanic acid, cefuroxime and quinolones. Average rates of susceptibility for amoxicillin- clavulanic acid, ciprofloxacin, cefuroxime, fosfomycin and nitrofurantoin were: 86,7, 75,4, 87,3, 97,6 and 96,2%, respectively. We observed a significantly increase of E. coli isolates producing extended-spectrum betalactamases (ESBLs), from 1,9% in 2003 to 4,9% in 2007 (χ2 TL = 143,6, p<0,001).
Conclusions: We observed a significantly reduction of E. coli susceptibility for most antibiotics and an increase of E. coli isolates producing ESBLs. Fosfomycin and nitrofurantoin are the best choices for empiric treatment. Prospective studies should be performed in the future to confirm the results of our study.

 
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Rev Esp Quimioter 2010:23(4):158-168

Nosocomial candidemia: new challenges of an emergent problem 

J. GÓMEZ, E. GARCÍA-VAZQUEZ, A. HERNÁNDEZ, C. ESPINOSA, J. RUIZ GÓMEZ   

 

Candida spp. are currently one of the most common causes of bloodstream infections in hospitals. Over the last two decades there has been a shift towards a greater involvement of non-Candida albicans as the cause of candidemia. Several of these non-albicans spp. (e.g., C. glabrata and C.krusei) exhibit resistance to traditional triazole antifungals (fluconazole), and cross-resistance with newer triazoles (voriconazole), focusing attention on the first-line use of antifungals such as the echinocandins, which possess improved activity against fluconazole-resistant strains. Early and adequate empirical treatment as well as early removing of the central catheters are the main factors related to mortality; thus it is necessary to implement guidelines of empirical treatment (including these aspects) in patients with risk factors and possible candidemia. Recent treatment guidelines from the Infectious Diseases Society of America (IDSA) recommend an echinocandin as primary therapy for non neutropenic or neutropenic patients with moderately severe to severe candidiasis and for patients at risk for infection with a triazole-resistant strain; the increasing MIC of echinocandins in case of C. parapsilosisis also an emerging concern. Clinicians should remain vigilant to prescribe early empiric treatment of patients at risk of having candidemia.   

 
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Rev Esp Quimioter 2011:24(2):74-78

Activity of vancomycin, ciprofloxacin, daptomycin, and linezolid against coagulase-negative staphylococci bacteremia   

M. FAJARDO, R. HIDALGO, S. RODRÍGUEZ, F. F. RODRÍGUEZ-VIDIGAL, A. VERA, M. ROBLES       

 

Objective. Multiresistant coagulase-negative staphylococci (CNS) infections are mainly increased in hospitalized patients. We have studied the activity of vancomycin, ciprofloxacin, daptomycin and linezolid in methicillin-resistant CNS strains, isolated from true blood cultures.
Methods. We collected 87 strains of different CNS species from positive blood cultures. Staphylococci were identified by MicroScan Walkaway (Dade Behring, Siemens) and with the Api ID 32 Staph (BioMerieux, France). The susceptibility to oxacillin, vancomycin and ciprofloxacin was performed by automatic microdilution plate as cited above. The susceptibility to daptomycin and linezolid was performed by Etest (AB BioMerieux, Solna, Sweden). Interpretative criteria were done following the CLSI guidelines.
Results. Eighty-seven CNS strains were studied: 55 (63%) were S. epidermidis, 15 (17%) S. haemolyticus, 10 (12%) S. hominis, and 7 (8%) other species. Fifty-three (61%) strains showed loss of susceptibility to vancomycin, MIC = 2 mg/L. Ciprofloxacin resistance, MIC > 2 mg/L, was observed in 56 (64%) strains. Daptomycin resistance was not observed, with a susceptibility range between 0.032-1 mg/L and modal value of 0.25 mg/L. Ten strains (11.5%) resistant to linezolid were observed. Nine patients were in ICU, where the average length of stay was 38 days (range 16-58 days) and one belonged to Hepato-Pancreatic Surgery, where he stayed for 64 days.
Conclusions. Low susceptibility to vancomycin is frecuent in the CNS strains studied in our hospital. Daptomycin shows a high efficacy against CNS, and it could be useful for the treatment of primary bacteremia or catheter associated bacteremia. The massive and continuous use of linezolid has led to the appearance of resistance. 

 
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