Revista espanola de quimioterapia : publicacion oficial de la Sociedad Espanola de Quimioterapia最新文献

Background: Carbapenem-resistant Enterobacterales (CRE) cause hard-to-treat infections. Rectal surveillance is widely used to detect carriers, but its predictive value where different carbapenemases co-circulate is unclear. We assessed whether CRE rectal and extra-rectal colonization predicts subsequent infection in an intensive care unit with concurrent KPC and NDM circulation.

Methods: We performed a retrospective observational study in a 60-bed adult intensive care unit in Buenos Aires, Argentina, from July 2016 to September 2019. All patients underwent weekly rectal surveillance, and extra rectal samples were taken when clinically indicated. Following up lasted 90 days from the first positive culture or from admission for non-carriers. Outcomes were any CRE infection and bacteremia. We estimated predictive values and fitted multivariable logistic regression models.

Results: We included 495 patients, median age 66 years, 58% male. Of them, 66% had rectal colonization and 8% had extrarectal colonization. CRE rectal carriage showed low PPV for any infection, about 10%, with high NPV near 94%, and it was not independently associated with infection (aOR 1.9 [0.9-4.4], p=0.1). CRE extra-rectal colonization was an independent predictor of any CRE infection (aOR 3.4 [1.4-7.9] p<0.01) and bacteremia (aOR 3.3 [1.3-8.9] p<0.05), with specificity >93% but sensitivity ≈ 20%.

Conclusions: In this mixed KPC and NDM CRE setting, weekly rectal surveillance was not a predictor of later infection, while extra rectal colonization retained independent predictive value for overall infection and for bacteremia.

Eravacycline is a novel, fully synthetic fluorocycline antibiotic with broad-spectrum activity against Gram-positive, Gram-negative, aerobic, and anaerobic pathogens, including multidrug-resistant (MDR) strains. It maintains efficacy despite common tetracycline resistance mechanisms, such as efflux pumps and ribosomal protection proteins. Its pharmacokinetic profile is characterized by extensive tissue penetration, particularly into the epithelial lining fluid and alveolar macrophages. Eravacycline is particularly active against MDR pathogens such as carbapenem-resistant Enterobacterales and Acinetobacter baumannii. It also demonstrates efficacy against Achromobacter spp., Burkholderia cepaciacomplex, Stenotrophomonas maltophilia, and rapidly growing mycobacteria. Moreover, owing to its minimal disruption of the intestinal microbiota, it may help reduce the risk of Clostridioides difficile infection and could serve as an adjunctive therapeutic option in severe or fulminant cases. Phase III trials (IGNITE1 and IGNITE4) demonstrated noninferiority of eravacycline compared with carbapenems in complicated intra-abdominal infections (cIAIs), supporting its approval for this indication. It is generally well tolerated, with adverse effects mainly limited to mild gastrointestinal. Beyond its approved indication for cIAIs, eravacycline shows therapeutic potential in multiple clinical contexts, such as polymicrobial infections from skin and soft tissue (necrotizing fasciitis) or pelvic inflammatory disease, pulmonary and biliary tract infections, β-lactam allergy, infections in immunocompromised patients, C. difficile infection, and community-acquired sepsis of unknown source. Collectively, real-world evidence and its broad-spectrum antimicrobial activity support eravacycline as a promising therapeutic option with potential utility extending beyond its current indications.

Introduction: Bacteremia and sepsis cause high morbidity and mortality worldwide. Rapid identification of bacteria and timely antimicrobial susceptibility testing (AST) can be crucial for patient survival. In the present study, we have compared isolates from patients whose ASTs were processed using MicroScan Walkaway Plus with those patients whose ASTs were processed more quickly using Vitek® Reveal™. We analyzed mortality, turnaround time to targeted therapy, and length of stay between the two groups, as well as other parameters.

Material and methods: In this prospective study, 120 patients with bacteremia caused by Gram-negative bacilli were included. In 60 patients, conventional AST (MicroScan WalkAway Plus) was performed, whereas in the other 60 patients, rapid AST (Vitek® Reveal™) was carried out.

Results: The mortality rates were 13.3% and 38.3% for patients whose ASTs were performed with Vitek® Reveal™ and MicroScan WalkAway Plus, respectively (p=0.002). The average length of stay was 18 days per patient in the Vitek® Reveal™ group and 24.5 days for the MicroScan group (p=0.128). The average turnaround time was 12 hours per patient for Vitek® Reveal™ and 40 hours for MicroScan (p<0.001).

Conclusions: The introduction of rapid AST techniques such as Vitek® Reveal™ has allowed a shorter turnaround time for reports on AST than when using normal AST techniques. This allows most AST results to be available earlier in the Laboratory Information System, allowing physicians to initiate more quickly in establishing correct treatment. Finally, these actions have resulted in reduced mortality due to faster clinical decision-making in these critically ill patients.

Introduction: Management of septic patients continues to be a major challenge in emergency departments, with hospital mortality exceeding 30%. Early and appropriate administration of antibiotic therapy is an essential pillar of initial treatment for sepsis, as delays or inadequacies significantly increase morbidity and mortality. However, the factors contributing to inadequate empirical treatment are still poorly understood. The objective of our study was to identify the risk factors associated with inadequate initial treatment in patients treated as code sepsis, as well as to evaluate the impact of the initial adequacy of empirical treatment on mortality.

Material and methods: Observational, retrospective cohort study conducted in the emergency department of a tertiary hospital (2021-2024). Inclusion: adults over 18 years of age with activated sepsis codes and positive blood cultures. The adequacy of initial empirical treatment, associated risk factors, and their effect on 7- and 30-day mortality were analyzed.

Results: 339 patients with sepsis were included; 56.9% were over 80 years of age. Factors associated with inadequate antibiotic treatment were Staphylococcus aureus and multidrug-resistant bacteria. A total of 33.6% of patients received inadequate empirical treatment. Mortality was 10.9% at 7 days and 17.1% at 30 days.

Conclusion: A significant proportion of patients with sepsis in emergency departments receive inadequate empirical therapy, which is associated with higher early mortality, especially in infections caused by S. aureus and multidrug-resistant bacteria.