[New therapeutic options for the treatment of multiresistant bacteria in the ICU]. / Nuevas opciones terapéuticas para el tratamiento de las bacterias multirresistentes en Unidades de Cuidados Intensivos.

The number of new antimicrobial drugs in the health care clinical practice has decreased gradually and significantly in the last 15 years. At the same time, there has been an increase in the appearance of microorganisms with resistance to conventional antibiotics, above all in intensive care units (ICU). Within this group, Methicillin-resistant Staphylococcus aureus (MSRA) and methicillin-resistant coagulase- negative staphylococci, vancomycin-resistant enterococci, Pseudomonas aeruginosa and Acinetobacter baumanii resistant to carbapenemics and extended-spectrum betalactamase-producing (ESBL) Enterobacteria are the most important. These pathogens are frequently also resistant to other groups of antibiotics such as aminoglycosides, fluoroquinolones and macrolides. New recently introduced antimicrobial agents are available to combat these resistances. These are active mainly against gram positive bacteria resistant strains and in a more timely way against gram negative ones or both. Among the first group, the following stand out: daptomycin (a lipopeptide bactericide for parenteral use) and linezolid (oxazolidinone with bacteriostatic activity for parenteral and oral use). On its part, ertapenem (a carbapenem parenteral bactericide) and tigecyclin (a parenteral bacteriostatic tetracycline) are active against ESBL enterobacteria, the latter also being active against non-fermented gram positives and gram negatives, except for P. aeruginosa. Possibly, the introduction of these new compounds and other futures ones pending introduction will not only improve antimicrobial diversification but also serve to limit the spreading of these microorganisms.

Nuevas opciones terapéuticas para el tratamiento de las bacterias multirresistentes en Unidades de Cuidados Intensivos / New therapeutic options for the treatment of multiresistant bacteria in the ICU

El número de nuevos antimicrobianos en la clínica asistencialha descendido de forma gradual y significativa enlos últimos 15 años. Paralelamente se ha producido un incrementoen la aparición de microorganismos con resistenciaa los antibióticos convencionales, sobre todo en las Unidadesde Cuidados Intensivos (UCI). Dentro de este grupo, laresistencia a la meticilina de Staphylococcus aureus (SARM) yde estafilococos coagulasa negativos resistentes a la meticilina,enterococos resistentes a la vancomicina, Pseudomonasaeruginosa y Acinetobacter baumannii resistentes a carbapenémicosy Enterobacterias productoras de betalactamasasde espectro extendido (BLEE) son las más destacables. Estospatógenos con frecuencia son además resistentes a otrosgrupos de antibióticos, como aminoglucósidos, fluorquinolonasy macrólidos. Para hacer frente a estas resistenciasdisponemos de nuevos antimicrobianos de reciente introducción.Éstos son activos principalmente frente a cepas resistentesde bacterias grampositivas, y de manera más puntualfrente a gramnegativos o a ambos. Entre los primerosdestacan: daptomicina (lipopéptido bactericida de uso parenteral)y linezolid (oxazolidinona bacteriostática de usoparenteral y oral). Por su parte, el ertapenem (carbapenembactericida parenteral) y la tigeciclina (tetraciclina bacteriostáticaparenteral) son activos frente a enterobacterias BLEE,siendo esta última además activa frente a grampositivos ygramnegativos no fermentadores, excepto P. aeruginosa. Posiblementela introducción de estos nuevos compuestos yotros futuros pendientes salir, aparte de mejorar la diversificaciónantimicrobiana, sirva para limitar la dispersión de estosmicroorganismos (AU)

The number of new antimicrobial drugs in the healthcare clinical practice has decreased gradually and significantlyin the last 15 years. At the same time, there hasbeen an increase in the appearance of microorganisms withresistance to conventional antibiotics, above all in intensivecare units (ICU). Within this group, Methicillin-resistantStaphylococcus aureus (MSRA) and methicillin-resistant coagulase-negative staphylococci, vancomycin-resistant enterococci,Pseudomonas aeruginosa and Acinetobacter baumaniiresistant to carbapenemics and extended-spectrumß-lactamase-producing (ESBL) Enterobacteria are themost important. These pathogens are frequently also resistantto other groups of antibiotics such as aminoglycosides,fluoroquinolones and macrolides. New recentlyintroduced antimicrobial agents are available to combatthese resistances. These are active mainly against grampositive bacteria resistant strains and in a more timelyway against gram negative ones or both. Among the firstgroup, the following stand out: daptomycin (a lipopeptidebactericide for parenteral use) and linezolid (oxazolidinonewith bacteriostatic activity for parenteral andoral use). On its part, ertapenem (a carbapenem parenteralbactericide) and tigecyclin (a parenteral bacteriostatictetracycline) are active against ESBL enterobacteria, thelatter also being active against non-fermented gram positivesand gram negatives, except for P. aeruginosa.Possibly, the introduction of these new compounds andother futures ones pending introduction will not onlyimprove antimicrobial diversification but also serve tolimit the spreading of these microorganisms (AU)

[Nosocomial infection by multiresistant pathogens during one year in a secondary hospital: clinical an epidemiological analysis]. / Infección nosocomial por gérmenes multirresistentes durante 1 año en un hospital de segundo nivel: análisis clínico y microbiológico.

BACKGROUND: Currently growing medical and social significance of nosocomial infection by multiresistant pathogens (NIMP) prompted us to establish its incidence, nosology, presenting forms in admission areas, and mortality in a secondary hospital, Lleida (Spain). METHOD: For that purpose, we analyzed the first year experience of a unit for the control of nosocomial infection (NI) created in our hospital. From January to December 2000, 79 patients with a NIMP admitted to the University Hospital Arnau de Vilanova entered in this prospective, descriptive study. RESULTS: The overall annual incidence of NIMP was 4.0 per 103 patients admitted. Acinetobacter baumannii showed the highest individual rate of incidence, particularly, at the Intensive Care Unit (15.4 per 103 patients admitted; p < 0.001). By nosologies, infection prevailed over colonization (69.6% vs 30.4%; p < 0.001). Mean hospital stay length increased in colonized patients (38.9 days). Finally, overall mortality was high (29.1%); again, A. baumannii was the agent most frequently detected in death cases (66.6%; p < 0.001). CONCLUSIONS: Surveillance and control measures are required for the prevention of NIMP. Incidence studies how this, can be useful to create a database to establish the distribution and occurrence of NI, including the detection of multiresistant pathogen outbreaks.

Infección nosocomial por gérmenes multirresistentes durante 1 año en un hospital de segundo nivel: análisis clínico y microbiológico / Nosocomial infection by multiresistant pathogens during one year in a secondary hospital: clinical and epidemiological analysis

Fundamento: Dada la gran relevancia actual, médica y social, de la infección nosocomial por gérmenes multirresistentes (INGM), se pretendió determinar su incidencia, nosología, formas de presentación en las áreas de ingreso y mortalidad en un hospital de 2º nivel en Lleida (España). Método: Se utilizó la experiencia de una unidad para el control de la Infección Nosocomial (IN), en su primer año de funcionamiento en este hospital. Por medio de la unidad, se practicó un estudio descriptivo prospectivo sobre todos los pacientes ingresados, en el Hospital Universitario Arnau de Vilanova, entre enero y diciembre de 2000 en los que se detectó una INGM. Resultados: En total fueron 79 pacientes los que presentaron una INGM. La tasa de incidencia global anual de INGM fue de 4,0 por 103 pacientes ingresados. A. baumannii fue el germen que obtuvo la tasa de incidencia individual más elevada, y en especial en la Unidad de Cuidados Intensivos (15,4 por 103 pacientes ingresados; p < 0,001). Por nosologías,la infección predominó sobre la colonización (69,6 frente 30,4%; p < 0,001). En general, se observó una estancia media más prolongada en los pacientes colonizados 38,9 días. Por último, la mortalidad total fue elevada (29,1%), destacando de nuevo A. baumannii, como el agente más frecuentemente detectado en los pacientes que fallecieron (66,6%; p < 0,001). Conclusiones: En la prevención de la INGM son necesarias medidas de vigilancia y control. Los estudios de incidencia como éste, pueden ser útiles a la hora de establecer una base de datos con la que observar la distribución y ocurrencia de la IN, incluyendo la detección de brotes epidémicos por gérmenes multirresistentes

Background: Currently growing medical and social significance of nosocomial infection by multiresistant pathogens (NIMP) prompted us to establish its incidence, nosology, presenting forms in admission areas, and mortality in a secondary hospital, Lleida (Spain). Method: For that purpose, we analyzed the first year experience of a unit for the control of nosocomial infection (NI) created in our hospital. From January to December 2000, 79 patients with a NIMP admitted to the University Hospital Arnau de Vilanova entered in this prospective, descriptive study. Results: The overall annual incidence of NIMP was 4.0 per 103 patients admitted. Acinetobacter baumannii showed the highest individual rate of incidence, particularly, at the Intensive Care Unit (15.4 per 103 patients admitted; p < 0.001). By nosologies, infection prevailed over colonization (69.6% vs 30.4%; p < 0.001). Mean hospital stay length increased in colonized patients (38.9 days). Finally, overall mortality was high (29.1%); again, A. baumannii was the agent most frequently detected in death cases (66.6%; p < 0.001). Conclusions: Surveillance and control measures are required for the prevention of NIMP. Incidence studies how this, can be useful to create adatabase to establish the distribution and occurrence of NI, including the detection of multiresistant pathogen outbreaks