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.  

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

Economic evaluation of interventions for infectious diseases in Spain: systematic review and comparative analysis      

F. CATALÁ-LÓPEZ, A. GARCÍA-ALTÉS, E.  ÁLVAREZ-MARTÍN, R. GÈNOVA-MALERAS, C. MORANT-GINESTAR            

 

Background: There exists the need to evaluate interventions addressed to prevent, control and reduce the burden of the infectious diseases; being economic evaluation an instrument can help to allocate healthcare resources efficiently. In this context, we assessed the evolution of economic evaluation of interventions for infectious diseases published in Spain, as well as we compared their main methodological characteristics with those of the studies directed to other diseases.
Methods: Systematic review and comparative analysis calculating odds ratios (OR). Electronic searches for literature beetwen 1983 and 2008 were conducted in PubMed/MEDLINE, SCOPUS, ISI Web of Knowledge, CRD, IME e IBECS, and manually in specialized journals and technical reports. The following variables were identified to analyze the characteristics of the reports: journal and year of publication, intervention, type of study, design, perspective, type of costs, financing source, and decision-making recommendations.
Results: One-hundred and one studies were included in the review. The main characteristics of the reports were: cost-effectiveness analysis (n=56; 55.4%), treatments evaluations (n=60;59.4%) and the use of decision analysis and mathematical simulation models (n=63; 62.4%). Economic evaluation studies of infectious diseases showed the following associations (compared to a cohort of studies of other disease conditions [n=376]): cost-benefit
analysis (OR, 3.55; 95% confidence interval [CI], 1.63 to 7.74), prevention (OR, 4.14; 95% CI, 2.49 to 6.90), and societal perspective (OR, 2.55; 95% CI, 1.43 to 4.56).
Conclusion: Although there is an increase in the number of economic evaluations of infectious diseases published during last decades, the studies showed heterogeneity in the quality of the information regarding methods of analysis and data sources.

 

 
Rev Esp Quimioter 2011:24(3):143-150 [pdf]

Pneumococcal bacteremia in adult patients at a hospital in Madrid: serotypes and susceptibility                 

M. CORREA, J. C. SANZ, C. DE LAS CUEVAS, A. GUIU, D. DOMINGO, T. ALARCÓN, M. LÓPEZ-BREA                                                                       

 
Introduction. The aim of this study is to describe the distribution of Streptococcus pneumoniae serotypes, its antimicrobial susceptibility profiles and the relation with vaccines in pneumococcal invasive strains isolated from blood cultures of adult patients.
Methods. All pneumococci isolated (67 strains) from blood cultures were serotyped by latex agglutination (Pneumotest latex) and Quellung reaction (Statens Serum Institut, Denmark). Antimicrobial susceptibility testing to penicillin (PEN), cefotaxime (CT), erythromycin (ERY) and levofloxacin (LEV) was performed by the E-test method (Biomèrieux, France).
Results. Among the 67 strains isolated, the most prevalent serotypes were 22F (11.9%) and 3 (11.9%), the second most frequent were 7F (7.5%) and 19A (7.5%). The coverage of the strains by the pneumococcal 7-valent conjugate vaccine (VNC7V), pneumococcal 13-valent conjugate vaccine (VNC13V) and pneumococcal 23-valent polysaccharide (VNP23V) were 16, 49 and 82%, respectively. Serotypes 22F and 3 were responsible for 14 of the 48 episodes of pneumonia with bacteremia (29.2%) and only 2 of the 19 episodes (10.5%) of bacteremia without pneumonia. According to the 2007 CLSI criteria, 12 strains (17.9%) were non-susceptible to penicillin. Eleven of this 12 strains (91.7%) were resistant to erythromycin, simultaneously.
Conclusions. The most common serotypes were 22F, 3, 7F y 19A. Three of them (3, 7F y 19A) are serotypes that are covered by the new VNC13V but not by VNC7V. Serotype 22F is a serotype emergent that is not covered by the VNC7V. The percentage of non-susceptibility to penicillin and resistance to erythromycin was comparable to the percentage reported in our country.

 

Rev Esp Quimioter 2012:25(2):155-160 [pdf]

Nonantimicrobial effects of tetracyclines

L. GARCÍA-ÁLVAREZ, J. A. OTEO

 

Tetracyclines are a family of antibiotics very common in clinical practice that have been used in not infectious affections. One of their most studied actions is their ability to inhibit matrix metalloproteinases (MMPs), a group of proteinases that have been implicated in pathological processes as oncogenesis and inflammation. Tetracyclines have been shown to play an important role in malignant angiogenesis and cancer invasion, which is related with tumor aggressiveness and metastatic potential. They also show anti-inflammatory activity in neurological, respiratory, bone and heart diseases, and in rheumatologic and dermatologic processes. The aim of this review is to make an updating about the non antimicrobial actions of tetracyclines, specially their therapeutic applications in different diseases.

 
Rev Esp Quimioter 2010:23(1):4-11 [pdf]

Prosthetic joint infection by Candida spp 

E. GARCÍA-OLTRA, S. GARCÍA-RAMIRO, J. C MARTÍNEZ, R. TIBAU, G. BORI, J. BOSCH, J. MENSA, A. SORIANO     

 

Introduction: Fungal periprosthetic infectionis a rare entity. The aim of this report was to review our experience in two different educational hospitals.
Material and methods: patients with documented prosthetic joint infection due to Candida spp. from February 2002 to October 2010 were retrospectively reviewed. Demographics, microbiological data, treatment and outcome of each patient was recorded.
Results: Ten patients, 8 women and 2 men, with a meanage of 77.7 (range 66-92) years were identified. Nine patients had previous bacterial infection, received antibiotic treatment for more than 15 days and required multiple surgeries. The most frequent species was C. albicans with 6 cases. All patients received fluconazole and surgical treatment consisted of debridement without removing the implant in 3 cases and 2-stage exchange with a spacer in 7. The first surgical and antifungal approach failed in all cases and a second debridement was necessary in one case, a resection arthroplasty in 8 and chronic suppressive treatment with fluconazol in one. After a mean follow-up of 31 (range 2-67) months, two patients were free of infection.
Conclusion: Prosthetic joint infection was associated with long-term antibiotic treatment and multiples previous surgeries. Treatment with fluconazol and debridement or two stage replacement with a spacer was associated with a high failure rate.    

 
Rev Esp Quimioter 2011:24(1):37-41 [pdf]