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. 

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

Invasive fungal infection in critically ill patient: role of micafungin                

M. NIETO, E. ESCUDERO                         

The invasive fungal infections (IFIs) have increased in critically ill patients in recent years and are a serious complication that determine the evolution and prognosis of critically ill patients, especially invasive candidiasis (IC) and candidemia. Fortunately, treatment options for these infections have increased and there is a large arsenal of antifungal agents. This review of the literature, using PubMed and Cochrane databases, assesses the situation of the IFIs in critically ill patients and discusses the role of micafungin in this context. The broader spectrum of this candin, which gets the antifungal effect with lower MICs and that translates into greater clinical efficacy with a lower rate of adverse effects and easier to use, with proven cost-effectiveness compared with other antifungal, position micafungin as a useful therapeutic option for the management of invasive candidiasis / candidemia in critically ill patients. 

 
Rev Esp Quimioter 2012:25(1):4-9 [pdf]

Liposomal amphotericin B: a unique pharmacokinetic profile. An unfinished story                

J. R. AZANZA, J. BARBERÁN                            

La anfotericina B en su formulación liposómica continúa siendo un fármaco de referencia en el tratamiento de las infecciones fúngicas sistémicas a pesar del tiempo transcurrido desde que se desarrolló. La ausencia de resistencias de los hongos, la farmacocinética, y el mejor perfil de tolerabilidad en relación con el resto formulaciones de anfotericina B, son motivos suficientes para justificar su protagonismo, El liposoma que contiene la anfotericina B liposómica es muy estable en relación con la presencia de colesterol y los fosfolípidos no presentan termolabilidad, por ello la anfotericina B apenas está presente en forma libre (<1%) lo que explica la baja incidencia de efectos relacionados con la administración y la reducción de la incidencia de nefrotoxicidad (mitad que con la anfotericina B complejo lipidico) y que incluso en algún estudio a dosis de 1 mg/kg se ha mostrado inexistente.Este perfil justifica concentraciones plasmáticas muy elevadas y un volumen de distribución y aclaramiento reducidos, con una semivida de eliminación muy prolongada. Existen evidencias que señalan que el liposoma a través de la anfotericina B es capaz de fijarse al ergosterol presente en membrana de hongo y sólo en ese momento se produciría la liberación del antifúngico que ejercería su efecto farmacológico.

 
Rev Esp Quimioter 2012:25(1):17-24 [pdf]

Respiratory infections: etiology and patterns of resistance in the hospital general of Ciudad Real                

 

 

I. CLEMENTE, M. D. MAÑAS, J. MARTÍNEZ, C. MONROY, M. SIDAHI, J. YANES                             

 

 

Objectives. Understanding the impact on our work place of increasing antibiotic resistance in respiratory infections.
Material and methods. We have performed a retrospective observational study on patients with significant sputum culture admitted to Internal Medicine Service Hospital General in Ciudad Real from January to December 2008. Information has been collected on the epidemiological, microbiological features, resistance patterns and treatment.
Results. The total number of patients included in this study was 60. In 83.3% there was a predisposing factor. In 43 cases the diagnosis was made in spring and summer months. The exacerbation of COPD was the most frequent diagnosis (61.7%). The most frequently isolated organism was Pseudomonas spp. (41.7%). In our hospital the most commonly used antimicrobials in the initial treatment are levofloxacin (36.7%) and amoxicillinclavulanate (26.7%). The antibiotics with the highest percentage of antibiotic resistance were ciprofloxacin in E. coli (66.7%) and Pseudomonas spp. (60%), penicillin for S. pneumoniae (100%).
Conclusions. The results of this study demonstrate the significant presence of resistance to most commonly used antibiotics in microorganisms which cause respiratory infections. 

 

 
Rev Esp Quimioter 2012:25(1):31-36 [pdf]

Phenotypes and mechanisms of resistance to macrolides and lincosamides in Streptococcus agalactiae isolates with clinical significance in an eight-year period (2002-2010)                

F. ARTILES, A. CAÑAS, I. ÁLAMO, B. LAFARGA                               

 

Introduction. Streptococcus agalactiae is the most prevalent agent of invasive disease in the newborn (sepsis, pneumonia, and meningitis), as well as an important cause of puerperal fever, urinary tract infection and surgical site infection. The aim of our study was to know the evolution of macrolide and lincosamide resistance in this microorganism.
Methods. Resistance phenotypes were established according to the erythromycin-clindamycin induction test: M (efflux pump) or MLS_B (methylase). Genetic mechanisms were detected by PCR for the following genes: ermB, ermA, ermTR, and mefA/E. Molecular typing was based on chromosomal DNA macrorestriction and detection of fragments using pulsed-field gel electrophoresis.
Results. During 8 years, 300 isolates of S. agalactiae were recovered. Seventy-eight (26%) were resistant to macrolides, and seventy (23%) were resistant to lincosamides. Constitutive MLS_B was observed in 21% of the isolates (all but one carrying the ermB gene), with a erythromycin MIC₉₀ ≥ 256 mg/L. Inducible MLS_B was observed in 2.3% of the isolates (all carrying the ermTR gene), with a MIC₉₀ of 6 mg/L. M phenotype was observed in 2.7% of the isolates (all carrying the mefA/E gene), with a MIC₉₀ of 6 mg/L. Molecular typing revealed the presence of two major clones (A and B) comprising 56.6% of the isolates. Most of the isolates (90.5%) belonging to clon A carried the ermB gene.
Conclusions. Macrolide resistance in our area is similar to that observed in the rest of Spain, but there has been no increase in the incidence rate along the study period. 

 
Rev Esp Quimioter 2012:25(1):42-46 [pdf]