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

Objective: To evaluate the impact of a multifaceted antimicrobial stewardship intervention on potentially unnecessary antibiotic prescribing.

Material and methods: Before and after quality control study carried out in three different settingsgeneral practice, out-of-hours services, and nursing homesin Spain. Healthcare professionals (both doctors and nurses) self-registered common infections using a specific template for each setting before (2022) and after (2023) receiving a 5-hour intervention on prudent antibiotic use.

Results: Eighty-nine professionals participated in the first registration (48 in general practice, 23 in out-of-hours services, and 15 in nursing homes), with 71 (79.8%) completing the intervention and second registration. Potentially unnecessary antibiotic prescriptions were 68.5%, 41.7%, and 77.7% in the first registration, respectively, and 61.4%, 34.8%, and 86.8% after the intervention, showing reductions of 10.4% in general practice and 16.5% in out-of-hours services, and an 11.7% increase in nursing homes, albeit without statistically significant differences.

Conclusions: The study found that this intervention slightly improved antibiotic use, with minimal impact, but worsened in nursing homes.

Pneumonia is the leading cause of death from infection in the developed world. In recent years, researchers and healthcare professionals have worked extensively to reduce this burden. Prevention is better than cure, and significant advances have been made in areas such as vaccination and the prevention of nosocomial pneumonia in intensive care units. Comprehensive surveillance programmes and new diagnostic methods have been developed to assess trends in this disease and to identify the infectious agents involved. Clinical presentation can be challenging in elderly patients or those with certain comorbidities, prompting new studies in these populations to address these issues. Correct and early management of severe community-acquired pneumonia represents a major opportunity to reduce its associated mortality. Although fungal pathogens are an uncommon cause of lung infection, they are associated with high morbidity and mortality, highlighting the need for new approaches. Finally, new drugs are available for the treatment of pneumonia, and a thorough understanding of them is key to ensuring their correct use, particularly to combat multi-resistance. To provide an update on these points, a multidisciplinary team of Spanish experts convened at the Sixth Annual Meeting of Pneumonia Day, under the scientific sponsorship of GEIPC-SEIMC. This paper reflects the information shared at this meeting, offering the latest insights on these topics and supporting a holistic approach to pneumonia management.

Human infections by Bordetella bronchiseptica are increasing in recent years. However, due to the lack of clinical susceptibility/resistance breakpoints, antimicrobial treatment is complex. Business Intelligence (BI) is a tool that allows to record and analyze large amounts of data in a very short time. The aim of this study was to analyze a cohort of patients with B. bronchiseptica infections focusing on how BI can help guide empirical antimicrobial therapy Demographic, clinical, and microbiological data about B. bronchiseptica infections were recovered. Then, MIC_50/90 of several antibiotics was automatically calculated through the BI. Thirteen B. bronchiseptica infections were identified. The lowest MICs₉₀ were for carbapenem, aminoglycoside, fluoroquinolones, and tetracyclines. The EUCAST PK-PD (non-species related) breakpoints showed that only piperacillin/tazobactam, imipenem and meropenem would be appropriate treatments to use empirically. In conclusion, BI systems have great potential to optimize the empirical antibiotic treatment in these types of infections.

Introduction: To analyse the concordance between theoretical and actual stratification of people living with HIV infection attending a pharmaceutical care outpatient clinic in a tertiary regional hospital.

Methods: Observational, retrospective, analytical, cross-sectional and single-centre study in people living with HIV infection. Study period: April 2024. Inclusion criteria: patients with HIV infection aged over 18 years who had been receiving active antiretroviral therapy (ART) for at least two years prior to inclusion. The 2022 version of the pharmaceutical care stratification model for people living with HIV infection was used. Reliability was evaluated from a qualitative perspective using Cohen's Kappa coefficient.

Results: Of the 199 patients attended during the study period, 100 were consecutively selected, of whom 93 were ultimately stratified. Men accounted for 77.41% of the cohort, with a mean age of 47.81 ± 12.53 years. The obtained stratification percentages were: Priority 1: 7.52%; Priority 2: 26.88%; Priority 3: 65.59%. Quantitative analysis of concordance between the models yielded a Cohen Kappa value of K=0.866.

Conclusions: There is a good concordance between the distribution percentages of the theoretical stratification and the actual one obtained in our study.

Introduction: The increased risk of tuberculosis (TB) reactivation in solid organ transplant recipients supports the recommendation of screening for latent tuberculosis infection (LTBI). Adherence to available screening tests has not been studied in the kidney transplant (KT) population. We aimed to assess screening compliance within the ATALANTA-DOS population study.

Methods: ATALANTA-DOS studied an intervention bundle aimed at preventing infection in KT recipients. We compared LTBI screening rates between the pre-intervention (February 2016 - September 2017) and intervention (February 2018 - September 2019) cohorts and evaluated adherence rates between the interferon-gamma release assay (IGRA) and the tuberculin skin test (TST).

Results: A total of 307 KT recipients were included (155 in the pre-intervention cohort; 148 in the intervention cohort). A systematic assessment of screening compliance by an infectious disease specialist on day +30 post-KT improved LTBI screening adherence (82.6% [114/138] vs 1.3% [2/155]; p-value <0.001). In the intervention cohort, compliance was higher with IGRA (83.3% [52/62]) than with TST (68.1% [49/72]). Two cases of LTBI were detected in the pre-intervention cohort and five in the intervention cohort (4.4% [5/114]). All patients completed LTBI treatment after ruling out active TB. No cases of active TB were identified during follow-up.

Conclusions: Systematic evaluation of LTBI screening compliance significantly increased screening completion rates among KT recipients. IGRA-based strategies increased screening compliance, supporting their implementation over TST for LTBI screening among KT recipients. Increased adherence would allow a more targeted and effective treatment of LTBI.