The use of systemic corticosteroids during Epstein-Barr virus (EBV)-induced infectious mononucleosis is a controversial but widespread practice. We aimed to investigate the frequency of complications in adolescents and adults with infectious mononucleosis in relation to the use of corticosteroids.
Methods
We reviewed the clinical records of 396 patients admitted to the hospital with infectious mononucleosis (52.0% male; median age, 19 years; range, 15–87 years), with a focus on both short-term (infectious and non-infectious) and long-term (hematological malignancies) complications in relation to corticosteroid use.
Results
A total of 155 (38.6%) patients received corticosteroids at some point during infectious mononucleosis. Corticosteroid use was significantly (P ≤ 0.002) associated with sore throat, lymphadenopathy, leukocytosis, and with antibiotics use (mainly indicated after suspicion of tonsillar bacterial superinfection). Overall, 139/155 (89.7%) patients who were treated with corticosteroids also received antibiotics either before or during hospitalization, compared with 168/241 (69.7%) patients who did not. The frequency of short-term severe complications, either infectious (peritonsillar–parapharyngeal abscess or bacteremia) or non-infectious (splenic rupture, severe thrombocytopenia, myopericarditis, or lymphocytic meningitis) were similar in patients receiving and not receiving corticosteroids. After a median of 15 years of follow-up, only one Hodgkin's lymphoma was diagnosed, in a patient who was not treated with corticosteroids during infectious mononucleosis.
Conclusions
The use of systemic corticosteroids during EBV-induced infectious mononucleosis is generally safe, at least with concomitant antibiotic therapy. However, this should not encourage the use of corticosteroids in this context, given that their efficacy has yet to be demonstrated.
{"title":"Are corticosteroids safe in adolescent and adult patients with infectious mononucleosis? A retrospective cohort study","authors":"Emilio-Manuel Páez-Guillán, Joaquín Campos-Franco, Rosario Alende, Arturo González-Quintela","doi":"10.1016/j.eimc.2023.10.004","DOIUrl":"10.1016/j.eimc.2023.10.004","url":null,"abstract":"<div><h3>Background and aim</h3><div>The use of systemic corticosteroids during Epstein-Barr virus (EBV)-induced infectious mononucleosis<span> is a controversial but widespread practice. We aimed to investigate the frequency of complications in adolescents and adults with infectious mononucleosis in relation to the use of corticosteroids.</span></div></div><div><h3>Methods</h3><div>We reviewed the clinical records of 396 patients admitted to the hospital with infectious mononucleosis (52.0% male; median age, 19 years; range, 15–87 years), with a focus on both short-term (infectious and non-infectious) and long-term (hematological malignancies) complications in relation to corticosteroid use.</div></div><div><h3>Results</h3><div>A total of 155 (38.6%) patients received corticosteroids at some point during infectious mononucleosis. Corticosteroid use was significantly (<em>P</em> <!-->≤<!--> <!-->0.002) associated with sore throat, lymphadenopathy, leukocytosis, and with antibiotics use (mainly indicated after suspicion of tonsillar bacterial superinfection). Overall, 139/155 (89.7%) patients who were treated with corticosteroids also received antibiotics either before or during hospitalization, compared with 168/241 (69.7%) patients who did not. The frequency of short-term severe complications, either infectious (peritonsillar–parapharyngeal abscess or bacteremia) or non-infectious (splenic rupture, severe thrombocytopenia, myopericarditis, or lymphocytic meningitis) were similar in patients receiving and not receiving corticosteroids. After a median of 15 years of follow-up, only one Hodgkin's lymphoma was diagnosed, in a patient who was not treated with corticosteroids during infectious mononucleosis.</div></div><div><h3>Conclusions</h3><div>The use of systemic corticosteroids during EBV-induced infectious mononucleosis is generally safe, at least with concomitant antibiotic therapy. However, this should not encourage the use of corticosteroids in this context, given that their efficacy has yet to be demonstrated.</div></div>","PeriodicalId":11608,"journal":{"name":"Enfermedades infecciosas y microbiologia clinica","volume":"43 1","pages":"Pages 10-16"},"PeriodicalIF":2.6,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138535698","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-01-01DOI: 10.1016/j.eimc.2023.07.002
Carolina Duarte , Clara Inés Agudelo , Carlos Castañeda-Orjuela , Jaime Moreno , Olga Marina Sanabria , Adriana Bautista , Elizabeth Castañeda
Introduction
The introduction of pneumococcal conjugate vaccine (PCV) into childhood vaccination programmes has reduced the prevalence of vaccine serotypes (VTs) that cause invasive pneumococcal disease (IPD) in children. In the elderly population, an impact has also been seen through indirect protection (herd effect). The aim of this study was to estimate the changes in serotype distribution and antimicrobial susceptibility of Streptococcus pneumoniae isolates recovered from adult IPD and to evaluate the indirect effect of immunization with PCV10 based on laboratory records by analyzing the period from 2005 to 2019 for six years before and eight years after the universal PCV10 administration to Colombian children.
Methods
A total of 2204 S. pneumoniae isolates from adults (≥50 years) with IPD were analyzed. The analysis examined the percentage changes in proportions (prevalence) and percentage variations in population rates (annual reported rates – ARR) of VTs between the pre-PCV10 (2005–2009) and post-PCV10 (2015–2019) periods.
Results
The findings were (1) evidence of a significant percentage decrease of pneumococcal VT10 causing IPD in adults (50% pre-PCV10 and 16% post-PCV10); (2) significant increase of serotype 19A (from 1.6% to 14.8%) and less important increase of serotype 3 (from 10.5% to 14.5%) and non-vaccine serotypes (NVT) (from 21.4% to 38.4%) non-significant; and (3) meningitis and non-meningitis multidrug resistant isolates associated with serotype 19A. An improvement in the surveillance system is associated with the immunization of children, as noted by the increased ARRs across the analysis period.
Conclusions
Our results show the indirect impact of PCV10 vaccination in children on the VT10 distribution and antimicrobial resistance of S. pneumoniae causing IPD in Colombian adults over 50 when comparing the pre-PCV10 (2005–2009) and post-PCV10 (2015–2019) periods.
{"title":"Indirect impact of PCV10 children vaccination on the serotype distribution and antimicrobial resistance of Streptococcus pneumoniae causing invasive disease in adults over 50 in Colombia, 2005–2019: Observational analysis","authors":"Carolina Duarte , Clara Inés Agudelo , Carlos Castañeda-Orjuela , Jaime Moreno , Olga Marina Sanabria , Adriana Bautista , Elizabeth Castañeda","doi":"10.1016/j.eimc.2023.07.002","DOIUrl":"10.1016/j.eimc.2023.07.002","url":null,"abstract":"<div><h3>Introduction</h3><div><span>The introduction of pneumococcal conjugate vaccine (PCV) into childhood vaccination programmes has reduced the prevalence of vaccine serotypes (VTs) that cause invasive pneumococcal disease (IPD) in children. In the elderly population, an impact has also been seen through indirect protection (herd effect). The aim of this study was to estimate the changes in serotype distribution and antimicrobial susceptibility of </span><span><span>Streptococcus pneumoniae</span></span> isolates recovered from adult IPD and to evaluate the indirect effect of immunization with PCV10 based on laboratory records by analyzing the period from 2005 to 2019 for six years before and eight years after the universal PCV10 administration to Colombian children.</div></div><div><h3>Methods</h3><div>A total of 2204 <span><em>S. pneumoniae</em></span> isolates from adults (≥50 years) with IPD were analyzed. The analysis examined the percentage changes in proportions (prevalence) and percentage variations in population rates (annual reported rates – ARR) of VTs between the pre-PCV10 (2005–2009) and post-PCV10 (2015–2019) periods.</div></div><div><h3>Results</h3><div>The findings were (1) evidence of a significant percentage decrease of pneumococcal VT10 causing IPD in adults (50% pre-PCV10 and 16% post-PCV10); (2) significant increase of serotype 19A (from 1.6% to 14.8%) and less important increase of serotype 3 (from 10.5% to 14.5%) and non-vaccine serotypes (NVT) (from 21.4% to 38.4%) non-significant; and (3) meningitis and non-meningitis multidrug resistant isolates associated with serotype 19A. An improvement in the surveillance system is associated with the immunization of children, as noted by the increased ARRs across the analysis period.</div></div><div><h3>Conclusions</h3><div>Our results show the indirect impact of PCV10 vaccination in children on the VT10 distribution and antimicrobial resistance of <em>S. pneumoniae</em> causing IPD in Colombian adults over 50 when comparing the pre-PCV10 (2005–2009) and post-PCV10 (2015–2019) periods.</div></div>","PeriodicalId":11608,"journal":{"name":"Enfermedades infecciosas y microbiologia clinica","volume":"43 1","pages":"Pages 3-9"},"PeriodicalIF":2.6,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"133831374","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-01-01DOI: 10.1016/j.eimc.2024.07.008
Ángela Sánchez-Simarro , Eliseo Albert , Paula Michelena , Estela Giménez , David Navarro
Introduction
The extent to which commercially available nucleic acid extraction platforms impact the magnitude of Cytomegalovirus (CMV) DNA loads measured in plasma specimens by 1st WHO standard-normalized real-time PCR assays is uncertain.
Methods
This retrospective study compares the performance of Abbott m2000sp, Qiagen QIAsymphony SP, and KingFisher Flex platforms using plasma samples from allogeneic hematopoietic stem cell transplant recipients and plasma spiked with the CMV AD169 strain. The Abbott RealTime CMV PCR assay was used for CMV DNA quantitation.
Results
Maximum differences in CMV DNA loads quantified in plasma from 11 allo-HSCT and spiked plasma over a wide range of viral DNA concentrations (2.0–4.0 log10 IU/ml) were ≤0.5 log10 IU/ml.
Conclusions
The CMV DNA extraction efficiency of the platforms evaluated varies. The impact of these variations on CMV DNA loads quantified in plasma may not be clinically relevant.
{"title":"Impact of automated nucleic acid extraction platforms on plasma Cytomegalovirus DNA loads quantitated by real-time PCR normalized to the 1st WHO international standard","authors":"Ángela Sánchez-Simarro , Eliseo Albert , Paula Michelena , Estela Giménez , David Navarro","doi":"10.1016/j.eimc.2024.07.008","DOIUrl":"10.1016/j.eimc.2024.07.008","url":null,"abstract":"<div><h3>Introduction</h3><div>The extent to which commercially available nucleic acid extraction platforms impact the magnitude of Cytomegalovirus (CMV) DNA loads measured in plasma specimens by 1st WHO standard-normalized real-time PCR assays is uncertain.</div></div><div><h3>Methods</h3><div>This retrospective study compares the performance of Abbott m2000sp, Qiagen QIAsymphony SP, and KingFisher Flex platforms using plasma samples from allogeneic hematopoietic stem cell transplant recipients and plasma spiked with the CMV AD169 strain. The Abbott RealTi<em>m</em>e CMV PCR assay was used for CMV DNA quantitation.</div></div><div><h3>Results</h3><div>Maximum differences in CMV DNA loads quantified in plasma from 11 allo-HSCT and spiked plasma over a wide range of viral DNA concentrations (2.0–4.0 log<sub>10</sub> IU/ml) were ≤0.5 log<sub>10</sub> IU/ml.</div></div><div><h3>Conclusions</h3><div>The CMV DNA extraction efficiency of the platforms evaluated varies. The impact of these variations on CMV DNA loads quantified in plasma may not be clinically relevant.</div></div>","PeriodicalId":11608,"journal":{"name":"Enfermedades infecciosas y microbiologia clinica","volume":"43 1","pages":"Pages 28-31"},"PeriodicalIF":2.6,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143104873","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-01-01DOI: 10.1016/j.eimc.2024.08.005
Rita González-Resina , Laura Eva Franco-Fobe , Concepción López-Gómez , Isabel Izquierdo-García
{"title":"Probable infección fúngica de brecha en paciente inmunodeprimido con aislamiento de una especie infrecuente","authors":"Rita González-Resina , Laura Eva Franco-Fobe , Concepción López-Gómez , Isabel Izquierdo-García","doi":"10.1016/j.eimc.2024.08.005","DOIUrl":"10.1016/j.eimc.2024.08.005","url":null,"abstract":"","PeriodicalId":11608,"journal":{"name":"Enfermedades infecciosas y microbiologia clinica","volume":"43 1","pages":"Pages 53-54"},"PeriodicalIF":2.6,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143104647","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-12-01DOI: 10.1016/j.eimc.2023.09.001
Yi-Hua Pan , Daniel K. Nomah , Marcos Montoro-Fernandez , Sergio Moreno-Fornés , Yesika Díaz , Jordi Aceitón , Andreu Bruguera , Josep M. Llibre , Pere Domingo , Arkaitz Imaz , Ingrid Vilaró , Vicenç Falcó , Juliana Reyes-Urueña , José M. Miro , Jordi Casabona , the PISCIS Cohort Study Group
Background
The COVID-19 pandemic disrupted healthcare services usage. We estimated the impact of the COVID-19 pandemic on healthcare services utilization among people living with HIV (PLWH) in Catalonia, Spain.
Methods
We accessed public healthcare usage in HIV units, primary care, hospitals, and emergency departments among 17,738 PLWH in the PISCIS cohort from January 1, 2017, to December 31, 2020. We performed an interrupted time series analysis using the autoregressive integrated moving average to estimate the effect of COVID-19 on medical visits and HIV monitoring among PLWH.
Results
A non-significant decrease of 17.1% (95% CI: [−29.4, 0.4]) in overall medical visits was observed during the lockdown, followed by a steady resumption until the end of 2020. Three health facilities presented statistically significant declines in visits during the lockdown: HIV units (−44.8% [−56.7, −23.6]), hospitals (−40.4% [−52.8, −18.1]), and emergency departments (−36.9% [−47.0, −21.9]); thereafter, the visits have begun to increase steadily but not to previous levels as of December 2020. In contrast, primary care visits remained unchanged during the lockdown by 1.9% (95% CI: −13.5, 23.9). CD4 cell (54.2% [95% CI: −64.4, −36.0]) and HIV RNA viral load (53.1% [95% CI: −62.9, −36.1]) laboratory monitoring reduced significantly during the lockdown.
Conclusion
COVID-19 lockdowns significantly disrupted in-person healthcare services usage among PLWH. The reduction in healthcare utilization however did not affect primary care services. Despite services gradually rebounding to pre-pandemic levels, it is imperative to effectively prepare for future pandemics and implement measures to ensure continuous provision of care to PLWH during pandemic lockdowns.
COVID-19大流行扰乱了医疗服务的使用。我们估计了COVID-19大流行对西班牙加泰罗尼亚艾滋病毒感染者(PLWH)医疗服务利用的影响。从2017年1月1日至2020年12月31日，我们调查了PISCIS队列中17738名PLWH的HIV单位、初级保健、医院和急诊科的公共医疗保健使用情况。我们使用自回归综合移动平均进行了中断时间序列分析，以估计COVID-19对PLWH中就诊和艾滋病毒监测的影响。在封锁期间，总体就诊人数下降了17.1% (95% CI:[- 29.4, 0.4])，但没有显著下降，随后稳步恢复，直到2020年底。在封锁期间，有三家卫生机构的就诊人数出现了统计上的显著下降:艾滋病毒病房(- 44.8%[- 56.7，- 23.6])、医院(- 40.4%[- 52.8，- 18.1])和急诊科(- 36.9% [- 47.0，- 21.9]);此后，访问开始稳步增加，但没有达到截至2020年12月的水平。相比之下，初级保健访问在封锁期间保持不变，为1.9%(95%置信区间:- 13.5,23.9)。在封锁期间，实验室监测CD4细胞(54.2% [95% CI: - 64.4， - 36.0])和HIV RNA病毒载量(53.1% [95% CI: - 62.9， - 36.1])显著下降。COVID-19封锁严重影响了公共卫生机构的面对面医疗服务使用。然而，医疗保健利用的减少并未影响初级保健服务。尽管服务逐渐恢复到大流行前的水平，但必须有效地为未来的大流行做好准备，并采取措施确保在大流行封锁期间继续向PLWH提供护理。COVID-19大流行interrumpió卫生服务中心。2019冠状病毒病大流行影响评估报告(网址:utilización)网址:艾滋病毒/艾滋病(PVV)患者健康服务报告(网址:Cataluña, España)。医疗器械和医疗器械有限公司pública在VIH大学、atención初级、医院和急救中心的注册信息，2017年1月1日至2020年1月31日。实现análisis一系列临时跨越性利用与预估móvil整合自回归与预估COVID-19的效果，并与其他咨询机构进行了协商，并与VIH中心和PVV进行了比较。Se observó una disminución no significant va del 17.1% (IC 95%: - 29,4 a 0,4)， en las visitas m ())， secguida de una reanudación constante hasta finales de 2020。医院(- 44,8% [- 56,7 a - 23,6])、医院(- 40,4% [- 52,8 a - 18,1])和急诊科(- 36,9% [- 47,0 a - 21,9]);在2020年之前，我们将为您提供一种全新的体验，一种全新的体验。Por el contrario, las visitas de atención primaria se mantuvieron sin cambios durante el confinamiento en 1,9% (IC IC 95%:−13,5 a 23,9)。El control de las analíticas de ccvlulas CD4 (54,2% [IC 95%:−64,4 a−36,0])和de la carga viral de ARN del VIH (53,1% [IC 95%:−62,9 a−36,1])均有显著性差异。COVID-19组织间的显著性变化及其对atención与个人有关的组织间的服务的影响。在禁运期间，la reducción en la utilización de la atención卫生保健没有afectó a los servicios de atención primary。在大流行之前，必须为预防大流行的有效管理做好必要的准备;在大流行之前，必须为预防大流行的有效管理做好必要的准备;在大流行之前，必须为预防大流行的持续atención做好必要的准备;在大流行之前，必须为预防大流行的持续atención做好准备。
{"title":"The impact of the COVID-19 pandemic on healthcare services utilization among people living with HIV in Catalonia, Spain: A population-based cohort study","authors":"Yi-Hua Pan , Daniel K. Nomah , Marcos Montoro-Fernandez , Sergio Moreno-Fornés , Yesika Díaz , Jordi Aceitón , Andreu Bruguera , Josep M. Llibre , Pere Domingo , Arkaitz Imaz , Ingrid Vilaró , Vicenç Falcó , Juliana Reyes-Urueña , José M. Miro , Jordi Casabona , the PISCIS Cohort Study Group","doi":"10.1016/j.eimc.2023.09.001","DOIUrl":"10.1016/j.eimc.2023.09.001","url":null,"abstract":"<div><h3>Background</h3><div>The COVID-19 pandemic disrupted healthcare services usage. We estimated the impact of the COVID-19 pandemic on healthcare services utilization among people living with HIV (PLWH) in Catalonia, Spain.</div></div><div><h3>Methods</h3><div>We accessed public healthcare usage in HIV units, primary care, hospitals, and emergency departments among 17,738 PLWH in the PISCIS cohort from January 1, 2017, to December 31, 2020. We performed an interrupted time series analysis using the autoregressive integrated moving average to estimate the effect of COVID-19 on medical visits and HIV monitoring among PLWH.</div></div><div><h3>Results</h3><div>A non-significant decrease of 17.1% (95% CI: [−29.4, 0.4]) in overall medical visits was observed during the lockdown, followed by a steady resumption until the end of 2020. Three health facilities presented statistically significant declines in visits during the lockdown: HIV units (−44.8% [−56.7, −23.6]), hospitals (−40.4% [−52.8, −18.1]), and emergency departments (−36.9% [−47.0, −21.9]); thereafter, the visits have begun to increase steadily but not to previous levels as of December 2020. In contrast, primary care visits remained unchanged during the lockdown by 1.9% (95% CI: −13.5, 23.9). CD4 cell (54.2% [95% CI: −64.4, −36.0]) and HIV RNA viral load (53.1% [95% CI: −62.9, −36.1]) laboratory monitoring reduced significantly during the lockdown.</div></div><div><h3>Conclusion</h3><div>COVID-19 lockdowns significantly disrupted in-person healthcare services usage among PLWH. The reduction in healthcare utilization however did not affect primary care services. Despite services gradually rebounding to pre-pandemic levels, it is imperative to effectively prepare for future pandemics and implement measures to ensure continuous provision of care to PLWH during pandemic lockdowns.</div></div>","PeriodicalId":11608,"journal":{"name":"Enfermedades infecciosas y microbiologia clinica","volume":"42 10","pages":"Pages 555-562"},"PeriodicalIF":2.6,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136010241","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-12-01DOI: 10.1016/j.eimc.2023.10.014
Félix Gutiérrez , Sergio Padilla , Javier García-Abellán , Ana Gutiérrez-Ortiz de la Tabla , Christian Ledesma , Mar Masiá
Objective
To assess the degree of implementation of cancer screening recommendations in people living with HIV (PLHIV) in Spain.
Methods
A self-administered questionnaire was designed on the strategies used for early detection of the main types of cancer in PLHIV. The survey was distributed electronically to HIV physicians participating in the Spanish CoRIS cohort.
Results
One hundred and six questionnaires were received from 12 different Spanish autonomous communities, with an overall response rate among those who accessed the questionnaire of 60.2%. The majority responded that they followed the clinical practice guidelines recommendations for the early detection of liver (94.3%), cervical (93.2%) and breast (85.8%) cancers. In colorectal and anal cancer, the proportion was 68.9% and 63.2%, and in prostate and lung cancer of 46.2% and 19.8%, respectively. In hospitals with a greater number of beds, a tendency to perform more cancer screening and greater participation of the infectious diseases/HIV services in the screening programs was observed. Significant differences were observed in the frequency of colorectal and anal cancer screening among the different autonomous communities. The most frequent reasons for not performing screening were the scarcity of material and/or human resources and not being aware of what is recommended in the clinical practice guidelines.
Conclusions
There are barriers and opportunities to expand cancer screening programs in PLHIV, especially in colorectal, anal and lung cancers. It is necessary to allocate resources for the early detection of cancer in PLHIV, but also to disseminate clinical practice guidelines screening recommendations among medical specialists.
{"title":"Cribado de cáncer en personas con VIH: aplicación en la práctica clínica y barreras percibidas por los médicos especialistas en España","authors":"Félix Gutiérrez , Sergio Padilla , Javier García-Abellán , Ana Gutiérrez-Ortiz de la Tabla , Christian Ledesma , Mar Masiá","doi":"10.1016/j.eimc.2023.10.014","DOIUrl":"10.1016/j.eimc.2023.10.014","url":null,"abstract":"<div><h3>Objective</h3><div>To assess the degree of implementation of cancer screening recommendations in people living with HIV (PLHIV) in Spain.</div></div><div><h3>Methods</h3><div>A self-administered questionnaire was designed on the strategies used for early detection of the main types of cancer in PLHIV. The survey was distributed electronically to HIV physicians participating in the Spanish CoRIS cohort.</div></div><div><h3>Results</h3><div>One hundred and six questionnaires were received from 12 different Spanish autonomous communities, with an overall response rate among those who accessed the questionnaire of 60.2%. The majority responded that they followed the clinical practice guidelines recommendations for the early detection of liver (94.3%), cervical (93.2%) and breast (85.8%) cancers. In colorectal and anal cancer, the proportion was 68.9% and 63.2%, and in prostate and lung cancer of 46.2% and 19.8%, respectively. In hospitals with a greater number of beds, a tendency to perform more cancer screening and greater participation of the infectious diseases/HIV services in the screening programs was observed. Significant differences were observed in the frequency of colorectal and anal cancer screening among the different autonomous communities. The most frequent reasons for not performing screening were the scarcity of material and/or human resources and not being aware of what is recommended in the clinical practice guidelines.</div></div><div><h3>Conclusions</h3><div>There are barriers and opportunities to expand cancer screening programs in PLHIV, especially in colorectal, anal and lung cancers. It is necessary to allocate resources for the early detection of cancer in PLHIV, but also to disseminate clinical practice guidelines screening recommendations among medical specialists.</div></div>","PeriodicalId":11608,"journal":{"name":"Enfermedades infecciosas y microbiologia clinica","volume":"42 10","pages":"Pages 563-569"},"PeriodicalIF":2.6,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138572023","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
This study aimed to present real-life data on the use, efficacy, and safety of administering antibiotic therapy through portable elastomeric pumps (pEP) in the outpatient setting.
Methods
This retrospective observational cohort study was conducted from January 2020 to May 2023 in a large academic hospital in Rome, Italy. All patients receiving antibiotic therapy via pEP were included up to a follow-up period of 90 days after the end of antibiotic therapy.
The primary outcome was the treatment response. Secondary endpoints were adverse events attributable to the drug administered, the vascular catheter, or the infection itself.
Results
Of the 490 patients referred to our outpatient parenteral antibiotic therapy (OPAT) unit, 94 (19.2%) received antibiotic therapy via pEP and were included in the final analysis. The most frequently treated infections were those involving bone and prosthetics, including spondylodiscitis (n = 27; 28.8%). Most infections were due to Pseudomonas aeruginosa (n = 55; 48.3%). Cefepime (n = 32; 34.0%), piperacillin/tazobactam (n = 29; 30.9%), ceftolozane/tazobactam (n = 7; 7.5%), and oxacillin (n = 7; 7.5%) were the most frequently administered antibiotics. The infection cure rate reached 88.3% (n = 83). 12 patients (12.8%) reported adverse events, of which half (6.4%) were drug-related and half (6.4%) were line-related.
Conclusions
OPAT through portable elastomeric infusion pumps proved to be safe and effective. It also contributed to the reduction of healthcare costs, fully respecting the principles of personalized medicine. This strategy has emerged as a promising tool for antibiotic stewardship and infection control.
{"title":"Outpatient parenteral antibiotic therapy (OPAT) through elastomeric continuous infusion pumps in a real-life observational study: Characteristics, safety, and efficacy analysis","authors":"Gabriele Giuliano , Domenico Tarantino , Enrica Tamburrini , Mario Cesare Nurchis , Giancarlo Scoppettuolo , Francesca Raffaelli","doi":"10.1016/j.eimc.2024.04.001","DOIUrl":"10.1016/j.eimc.2024.04.001","url":null,"abstract":"<div><h3>Introduction</h3><div>This study aimed to present real-life data on the use, efficacy, and safety of administering antibiotic therapy through portable elastomeric pumps (pEP) in the outpatient setting.</div></div><div><h3>Methods</h3><div>This retrospective observational cohort study was conducted from January 2020 to May 2023 in a large academic hospital in Rome, Italy. All patients receiving antibiotic therapy via pEP were included up to a follow-up period of 90 days after the end of antibiotic therapy.</div><div>The primary outcome was the treatment response. Secondary endpoints were adverse events attributable to the drug administered, the vascular catheter, or the infection itself.</div></div><div><h3>Results</h3><div>Of the 490 patients referred to our outpatient parenteral antibiotic therapy (OPAT) unit, 94 (19.2%) received antibiotic therapy via pEP and were included in the final analysis. The most frequently treated infections were those involving bone and prosthetics, including spondylodiscitis (<em>n</em> <!-->=<!--> <!-->27; 28.8%). Most infections were due to <em>Pseudomonas aeruginosa</em> (<em>n</em> <!-->=<!--> <!-->55; 48.3%). Cefepime (<em>n</em> <!-->=<!--> <!-->32; 34.0%), piperacillin/tazobactam (<em>n</em> <!-->=<!--> <!-->29; 30.9%), ceftolozane/tazobactam (<em>n</em> <!-->=<!--> <!-->7; 7.5%), and oxacillin (<em>n</em> <!-->=<!--> <!-->7; 7.5%) were the most frequently administered antibiotics. The infection cure rate reached 88.3% (<em>n</em> <!-->=<!--> <!-->83). 12 patients (12.8%) reported adverse events, of which half (6.4%) were drug-related and half (6.4%) were line-related.</div></div><div><h3>Conclusions</h3><div>OPAT through portable elastomeric infusion pumps proved to be safe and effective. It also contributed to the reduction of healthcare costs, fully respecting the principles of personalized medicine. This strategy has emerged as a promising tool for antibiotic stewardship and infection control.</div></div>","PeriodicalId":11608,"journal":{"name":"Enfermedades infecciosas y microbiologia clinica","volume":"42 10","pages":"Pages 581-587"},"PeriodicalIF":2.6,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141036287","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-12-01DOI: 10.1016/j.eimc.2024.02.003
Melisa Hernández-Febles , Miguel Ángel Cárdenes Santana , Rafael Granados Monzón , Xerach Bosch Guerra , María José Pena López
Introduction
In Spain, half of new HIV diagnoses are late and a significant proportion of people living with HIV have not yet been diagnosed. Our aim was to evaluate the effectiveness of an automated opportunistic HIV screening strategy in the hospital setting.
Methods
Between April 2022 and September 2023, HIV testing was performed on all patients in whom a hospital admission analytical profile, a pre-surgical profile and several pre-designed serological profiles (fever of unknown origin, pneumonia, mononucleosis, hepatitis, infection of sexual transmission, rash, endocarditis and myopericarditis) was requested. A circuit was started to refer patients the specialists.
Results
6,407 HIV tests included in the profiles were performed and 18 (0.3%) new cases were diagnosed (26.4% of diagnoses in the health area). Five patients were diagnosed by hospital admission and pre-surgery profile and 13 by a serological profile requested for indicator entities (fever of unknown origin, sexually transmitted infection, mononucleosis) or possibly associated (pneumonia) with HIV occult infection. Recent infection was documented in 5 (27.8%) patients and late diagnosis in 9 (50.0%), of whom 5 (55.5%) had previously missed the opportunity to be diagnosed.
Conclusions
This opportunistic screening was profitable since the positive rate of 0.3% is cost-effective and allowed a quarter of new diagnoses to be made, so it seems a good strategy that contributes to reducing hidden infection and late diagnosis.
{"title":"Evaluación de una estrategia de cribado del VIH en el entorno hospitalario para reducir la infección oculta","authors":"Melisa Hernández-Febles , Miguel Ángel Cárdenes Santana , Rafael Granados Monzón , Xerach Bosch Guerra , María José Pena López","doi":"10.1016/j.eimc.2024.02.003","DOIUrl":"10.1016/j.eimc.2024.02.003","url":null,"abstract":"<div><h3>Introduction</h3><div>In Spain, half of new HIV diagnoses are late and a significant proportion of people living with HIV have not yet been diagnosed. Our aim was to evaluate the effectiveness of an automated opportunistic HIV screening strategy in the hospital setting.</div></div><div><h3>Methods</h3><div>Between April 2022 and September 2023, HIV testing was performed on all patients in whom a hospital admission analytical profile, a pre-surgical profile and several pre-designed serological profiles (fever of unknown origin, pneumonia, mononucleosis, hepatitis, infection of sexual transmission, rash, endocarditis and myopericarditis) was requested. A circuit was started to refer patients the specialists.</div></div><div><h3>Results</h3><div>6,407 HIV tests included in the profiles were performed and 18 (0.3%) new cases were diagnosed (26.4% of diagnoses in the health area). Five patients were diagnosed by hospital admission and pre-surgery profile and 13 by a serological profile requested for indicator entities (fever of unknown origin, sexually transmitted infection, mononucleosis) or possibly associated (pneumonia) with HIV occult infection. Recent infection was documented in 5 (27.8%) patients and late diagnosis in 9 (50.0%), of whom 5 (55.5%) had previously missed the opportunity to be diagnosed.</div></div><div><h3>Conclusions</h3><div>This opportunistic screening was profitable since the positive rate of 0.3% is cost-effective and allowed a quarter of new diagnoses to be made, so it seems a good strategy that contributes to reducing hidden infection and late diagnosis.</div></div>","PeriodicalId":11608,"journal":{"name":"Enfermedades infecciosas y microbiologia clinica","volume":"42 10","pages":"Pages 577-580"},"PeriodicalIF":2.6,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140127018","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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