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.

 
Rev Esp Quimioter 2010:23(2):93-99 [pdf]

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Rev Esp Quimioter 2011:24(1):4-12

Proton pump inhibitors and infection risk 

E. PALENCIA-HERREJÓN, B. SÁNCHEZ, I. ESCOBAR, M. L. GÓMEZ-LUS   

 

Gastric antisecretory drugs, especially proton pump inhibitors, are among the most used drugs both in ambulatory and hospital settings, and prescription does not always follows approved indications. Experimental data suggest that gastric acid inhibition and the effects of proton pump inhibitors on the immune system can promote the development of infections. In recent years a number of observational studies have found an independent association between the use of proton pump inhibitors and an increased risk of gastrointestinal infections, including those caused by Clostridium difficile, and community and nosocomial pneumonia. This review discusses the current evidence, raises the potential pathogenic mechanisms involved and makes recommendations for current clinical practice and future research.    

 
Rev Esp Quimioter 2011:24(1):4-12 [pdf]

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Rev Esp Quimioter 2011:24(3):123-126

Side effects of benznidazole treatment in a cohort of patients with Chagas disease in non-endemic country    

B. CARRILERO, L. MURCIA, L. MARTINEZ-LAGE, M. SEGOVIA           

 

Chagas disease is a disease endemic in Latin America, caused by the parasite Trypanosoma cruzi. Benznidazole is the most commonly used drug for the etiological treatment of the disease although its effectiveness varies according to the phase of the same and toxic side effects are frequent. This prospective study describes the side effects of benznidazole treatment of a cohort of 373 chronic patients. Of these 40.2% presented adverse reactions. The most frequent side effect were dermatological reactions 32.4% (121 of 373) followed by digestive intolerance 9.1% (34 of 373). Surprisingly, three cases of migratory arthritis were observed. Patients treated with benznidazole must be followed up so that the long term incidence of side effects can be studied.

 
Rev Esp Quimioter 2011:24(3):123-126 [pdf]

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Rev Esp Quimioter 2011:24(4):233-262

Consensus document on treatment of infections in diabetic foot             

J.I. BLANES Y REPRESENTANTES DE LA ASOCIACIÓN ESPAÑOLA DE CIRUJANOS (AEC); SOCIEDAD ESPAÑOLA DE ANGIOLOGÍA Y CIRUGÍA VASCULAR Y (SEACV); SOCIEDAD ESPAÑOLA DE MEDICINA DE URGENCIAS Y EMERGENCIAS (SEMES); SOCIEDAD ESPAÑOLA MEDICINA INTERNA (SEMI); SOCIEDAD ESPAÑOLA DE MEDICINA INTENSIVA, CRÍTICA Y UNIDADES CORONARIAS (SEMICYUC) Y SOCIEDAD ESPAÑOLA DE QUIMIOTERAPIA (SEQ)                      

Diabetic foot infection, particularly if it is associated to ischaemia, is the most common cause of lower limb amputation, in the general population, of hospital admissions, and a decrease in the quality of life in diabetics. Of all diabetics, 15% of them are going to suffer from a foot infection during their life, with an annual incidence of 1-4%, preceded by a foot ulcer in more than 80% of cases. They are complex infections and the prognosis is influenced by many factors, depending on the ulcer (location, extension, whether chronic or not, previous amputation, ischaemia grade), and the patient (age, renal impairment, time of onset of diabetes, associated comorbidity). All these must be taken into account when establishing its treatment. The infections must be classified according to their severity (mild, moderate-mild, moderatesevere, and severe). Their treatment is complex and must be multidisciplinary and must include debridement, discharge, adequate antibiotic therapy, revascularisation, and treatment of the ulcer.
In this consensus document, produced in collaboration with the Spanish Angiology and Vascular Surgery Society (SEACV), the Spanish Society of Internal Medicine (SEMI), the Spanish Chemotherapy Society (SEQ), the Spanish Surgeons Association (AEC), the Spanish Society of Urgent Medicine and Emergencies (INFURG-SEMES) and the Spanish Society of Intensive and Critical Medicine and Coronary Care (SEMICYUC), the guidelines are developed based on the best available evidence on diabetic foot infections, aimed at achieving greater clinical efficacy. 

 
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Rev Esp Quimioter 2012:25(2):129-133

Peripheral venous catheter-related bacteremia in a general hospital     

M. DELGADO-CAPEL, A. GABILLO, L. ELIAS, J. C. YÉBENES, G. SAUCA, J. A. CAPDEVILA                                                               

 
Introduction. Catheter sepsis is a constant and serious problem in our hospitals for the cost it generates, both in terms of morbidity and economics. It’s becoming more frequent also in peripherally inserted catheters. Our study aims to know the importance and characteristics of peripheral venous catheter bacteremia in a general hospital.
Material and methods. Prospective and comparative analysis of all episodes of central and peripheral venous catheter-related bacteraemia, in 2009.
Results. Twenty-eight episodes of catheter-related bacteraemia in a total of 25 patients. Sixteen episodes originated in central catheter (57.2%), 11 in peripheral (39.3%) and 1 in peripherally inserted central catheter (3.5%). Two cases of exitus directly related to the peripheral catheter infection. Etiology: 13 episodes of S. aureus (3 MRSA), including 8 in peripheral catheter (8/13, 61.5%), 12 episodes of plasma coagulase negative staphylococcus, including 2 in peripheral catheter (2/12, 16.6%).
Conclusions. Peripheral catheter-related bacteraemia is an emerging health problem with important clinical and prognostic connotations for patients. It is necessary continuous training on correct handling measures to prevent intravascular catheters infections including peripheral catheters in every hospital ward. 

 

Rev Esp Quimioter 2012:25(2):129-133 [pdf]

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Rev Esp Quimioter 2012:25(4):256-260

Evaluation of the Sensititre Yeast One microdilution method for susceptibility testing of Candida species to anidulafungin, caspofungin, and micafungin                    

L. GARCÍA-AGUDO, P. GARCÍA-MARTOS, J. MARTOS-CAÑADAS, P. AZNAR-MARÍN, P. MARÍN-CASANOVA, M. RODRÍGUEZ-IGLESIAS                                                                                 


Introduction. Echinocandins represent a new antifungal group with potent activity against Candida species. The purpose of our study was to evaluate the utility of the Sensititre Yeast One method to determine the in vitro activity of anidulafungin, micafungin, and caspofungin against Candida species isolated from clinical specimens.
Methods. A total of 131 Candida strains were tested using Sensititre Yeast One colorimetric microdilution method. They belonged to the following species: 42 C. albicans, 36 C. glabrata, 21 C. parapsilosis, 12 C. tropicalis, 10 C. krusei, 3 C. guilliermondii, 2 C. famata, 3 C. kefyr, 1 C. lusitaniae, 1 C. zeylanoides, and 1 C. lipolytica. For being considered susceptible the strains had to be inhibited by concentrations ≤2 mg/L of anidulafungin, caspofungin or micafungin.
Results. The 80.1% of the strains tested were inhibited by concentrations ≤0.25 mg/L of anidulafungin and micafungin. The activity of caspofungin was slightly lower (78.6% of strains inhibited by concentrations ≤0.25 mg/L). The 96.9% of strains turned out susceptible to concentrations ≤2 mg/L against the three echinocandins. Two strains of C. parapsilosis (9.5%), one of C. guilliermondii, and two of C. famata showed non-susceptible to one or more echinocandins.
Conclusions. In our series, anidulafungin, micafungin, and caspofungin were effective against C. albicans, C. glabrata, C. tropicalis, C. krusei, C. kefyr, C. lusitaniae and C. lipolytica. The 96.9% of strains were susceptible to all three echinocandins. Thus, echinocandins are proved to exhibit excellent activity to the Candida species most frequently involved in human infections, except Candida parapsilosis.  

 

Rev Esp Quimioter 2012:25(4):256-260 [pdf]

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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 2011:24(1):13-24

Role of daptomycin in the empirical and directed therapy of infections caused by Gram-positive bacteria in the critically ill patient

J. GARNACHO-MONTERO, R. AMAYA-VILLAR, M. L. GÓMEZ-GRANDE, V. JEREZ, L. LORENTE-RAMOS, A. LOZA, A. MARTÍNEZ, J. C. POZO, R. SIERRA, J. POMARES, M. V. DE LA TORRE, C. ORTIZ   

 

Infections caused by Gram-positive bacteria are a serious problem and is associated with high mortality. Among them, we should highlight those caused by methicillin-resistant Staphylococcus aureus (MRSA). Primary bacteremia, catheter-related bloodstream infections and constitute the main presentations. Vancomycin has traditionally been the treatment of choice for these infections, but its activity is not satisfactory especially in cases of MRSA with minimum inhibitory concentration (MIC) > 1 mg/L. Daptomycin is a lipopeptide antibiotic active against Gram-positive bacteria including MRSA and glycopeptide-resistant Enterococcus spp.It is worth mentioning that daptomycin is rapidly bactericidal against methicillin-sensitive S. aureus, more potent than vancomycin and at least as active as isoxazole penicillins. This article discusses the role of this antibiotic in the empirical treatment of infections and directed by Gram-positive bacteria affecting critically ill patients.    

 
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Rev Esp Quimioter 2011:24(3):127-130

In vitro activity of retapamulin against linezolid and methicillin–resistant Staphylococcus aureus isolates       

F. J. CANDEL, G. MORALES, J. J. PICAZO           

 

 

Objectives: To determine the in vitro activity of retapamulin and other topical antibiotics (mupirocin, bacitracin, and fusidic acid) usually employed for nasal decolonization, against methicillin-susceptible Staphylococcus aureus (MSSA), methicillin-resistant S. aureus (MRSA), and linezolid and methicillin–resistant S. aureus.
Methods: The minimum inhibitory concentrations (MICs) were determined on Mueller-Hinton agar according to the guidelines of the Clinical and Laboratory Standards Institute and of the European Committee for Antimicrobial Susceptibility Testing. Presence of the cfr gene in linezolid and methicillin–resistant S. aureus isolates was detected using polymerase chain reaction.
Results: Retapamulin inhibited all the isolates of MSSA and MRSA at 0.125 mg/L, but the 18 linezolid-resistant-MRSA strains proved resistant, with MICs over 32 mg/L. Most MSSA isolates (9/10) were susceptible to mupirocin with MICs under 0.19 mg/L, although this value decreased to half against MRSA, and almost all linezolid-resistant MRSA (17/18) strains were resistant to mupirocin with an MIC range of between 8 mg/L and 28 mg/L. The MIC of fusidic acid increased substantially against linezolid-resistant MRSA, whereas that of bacitracin showed no differences.
Conclusions: Retapamulin demonstrated excellent in vitro activity against MSSA and MRSA strains, but not against MRSA isolates harbouring the cfr gene. The results of this in vitro study support cut-off values for retapamulin of ≤ 0.5, 1, and ≥ 2 mg/L for susceptible, intermediate, and resistant strains, respectively.

 
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Rev Esp Quimioter 2011:24(4):263-270

Recommendations for the treatment of invasive fungal infection caused by filamentous fungi in the hematological patient                

J. BARBERÁN, J. MENSA, J. C. VALLEJO, I. JARQUE, J. C. GARCÍA, J. R. CABRERA, P. BALTASAR, J. BESALDUCH, J. M. CALVO, F.  J.  CAPOTE, E. CARRERAS, M. L. DÍAZ, F. ESCALANTE, P. FERNÁNDEZ, S. GARZÓN, C. GRANDE, D. HERNÁNDEZ, A. LÓPEZ, J. LÓPEZ, E. MARTÍN, M. OLAVE, J. PÉREZ, G. RAMÍREZ, R. ROJAS, A. ROMÁN, M. ROVIRA, D. RUBIO, P. SÁNCHEZ , A. SÁNCHEZ, J. DE LA SERNA, C. SOLANO, D. VALCÁRCEL, J. M. AGUADO, J. R. AZANZA, R. CANTÓN , R. CISTERNA, J. DÍAZ, J. FORTÚN, J. GARCÍA, J. GÓMEZ, E. GÓMEZ, J.  M. MONTEJO, F. J. PEMÁN, I. RUIZ, M. SALAVERT, M. A. SANZ, J. DE LA TORRE, L. VÁZQUEZ                        

Antifungal treatment in the hematological patient has reached a high complexity with the advent of new antifungals and diagnostic tests, which have resulted in different therapeutic strategies. The use of the most appropriate treatment in each case is essential in infections with such a high mortality. The availability of recommendations as those here reported based on the best evidence and developed by a large panel of 48 specialists aimed to answer when is indicated to treat and which agents should be used, considering different aspects of the patient (risk of fungal infection, clinical manifestations, galactomanann test, chest CT scan and previous prophylaxis) may help clinicians to improve the results. 

 
Rev Esp Quimioter 2011:24(4):263-270 [pdf]

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