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

Introduction: Current antimicrobial susceptibility methods fail to capture the variability of AmpC induction pathways in Pseudomonas aeruginosa. This leads to preventable errors in ceftazidime susceptibility reporting. We introduce a reinterpretation for the disk approximation test, based on the categorical change in ceftazidime susceptibility upon imipenem exposure.

Materials and methods: A total of 73 ceftazidime-susceptible P. aeruginosa isolates were evaluated. Automated broth microdilution test was the reference standard. AmpC inducibility was conventionally defined as a ≥5 mm flattening of the ceftazidime inhibition zone adjacent to imipenem. Our novel criterion for inducibility was a change in ceftazidime category from susceptible to nonsusceptible. The probability of error in ceftazidime reporting was evaluated with three parameters. ROC curve, comparative and regression analyses were performed.

Results: The reference method showed an overall error probability of 35.6%. The conventional 5 mm cutoff interpretation reduced this rate to 5.4%, but generated a significant proportion of false positives and negatives. Regression analyses showed that the flattening effect is a strong predictor of the categorical change. No association was found between basal ceftazidime susceptibility and AmpC inducibility.

Conclusion: Our reinterpretation criterion for disk approximation test turns a phenotypic assay into a clinically relevant diagnostic tool to avoid errors in ceftazidime susceptibility reports. Moreover, this interpretation is readily applicable in routine microbiology laboratories, and has the potential to be directly useful for antimicrobial stewardship efforts.

Introduction: Brucella-associated primary peritonitis is an exceptionally rare condition that may present as spontaneous bacterial peritonitis (SBP) or peritoneal dialysis-related peritonitis (PDrP). We investigated demographic and clinical characteristics of these two entities caused by Brucella species.

Methods: A systematic review of the literature was undertaken to identify published cases of primary peritonitis caused by Brucella species and perform comparative analysis. Cases were categorized as SBP or PDrP and analyzed for demographics, clinical features, microbiology, treatment regimens and outcomes.

Results: A total of 33 cases were identified: 22 of SBP and 11 of PDrP. Among these, SBP cases occurred predominantly in older cirrhotic males (mean age 55.2 years), with Brucella isolated mainly from blood cultures (72.7%) and an associated mortality rate of 13.6%. In contrast, PDrP cases involved younger, generally healthier individuals on PD (mean age 47.5 years), where Brucella was universally isolated from peritoneal fluid and mortality was 0%. Catheter removal was required in 36.4% of PDrP cases. Epidemiological risk factors were more common in PDrP (81.8% vs. 45.5%). Blood culture positivity was significantly higher in SBP (p=0.016), while peritoneal fluid cultures were more often diagnostic in PDrP (p=0.028). Most patients received combination therapy with doxycycline and rifampicin, while treatment duration tended to be longer in PDrP.

Conclusion: Brucella peritonitis shows differing patterns in SBP and PDrP. Early identification and appropriate intervention are essential for favorable clinical results.

Despite progress in adult vaccination schedules, coverage rates remain suboptimal in Spain. This opinion paper, authored by a multidisciplinary group of experts, analyzes the causes and consequences of adult undervaccination, covering clinical, social, economic, and ethical aspects. Over 10 million individuals aged 65+ are targeted for vaccination, along with adults with chronic illnesses. However, coverage remains low, with significant disparities across vaccines, regions, and risk groups. The causes of the "vaccination gap" include lack of training among healthcare professionals, organizational barriers, misinformation, low-risk perception among the public, and weak institutional engagement. This situation leads to increased morbidity, mortality, and avoidable costs for the healthcare system. Universal adult vaccination could significantly reduce these burdens. The document outlines structured solutions: targeted professional training, multicomponent strategies, centralized vaccination registries, effective public awareness campaigns, improved access, and integration of vaccination across all healthcare levels. The key role of healthcare workers, patient organizations, and the media is emphasized in improving vaccination coverage.

Sepsis is a life-threatening condition resulting from the body's dysregulated response to infection that demands timely diagnosis and effective antimicrobial treatment to reduce mortality and healthcare burden. Microbiology laboratories play a critical role in sepsis management by delivering rapid and accurate diagnostic information. This article explores the framework and implementation of diagnostic stewardship programs, their integration with antimicrobial stewardship programs, and the evolving microbiological techniques enabling earlier, targeted antimicrobial therapy in sepsis. We highlight the critical synergy between microbiology, clinical teams and innovation, in optimizing patient outcomes.

The spread of metallo-β-lactamases (MBL)-producing Gram-negative bacilli represents a global health challenge, associated with increased mortality rates. The prevalence of MBL-producing isolates, particularly of New Delhi metallo-β-lactamase (NDM) subclass, is increasing globally. The optimal antibiotic for infections depends on the species and MBL subclass produced. Currently, the antimicrobial cornerstones against these pathogens are aztreonam/avibactam and cefiderocol. Successful therapy requires the early and adequate initiation of antibiotic treatment, optimisation of its pharmacokinetics/pharmacodynamics, and appropriate control of the infection source.

Nosocomial pneumonia is one of the most common nosocomial infections and is associated with significant clinical and economic burdens, such as long-term hospitalization, high medical costs, and increased morbidity and mortality. The increasing incidence of nosocomial pneumonia caused by multidrug-resistant bacteria is a challenge in certain clinical settings, as it often carries a higher risk of delays in initiating an appropriate treatment and, therefore, a worse prognosis. The aim of this article is to analyze some of the key aspects that should be taken into account when choosing an antibiotic treatment for a patient with a nosocomial pneumonia in a multidrug-resistant environment.

Primary immunodeficiencies, now referred to as inborn errors of immunity (IEI), are increasingly recognized in adults, not only in the pediatric population. In adults, they may present with recurrent, severe, or unusual infections, but also with autoimmunity, malignancy, allergies, or inflammation, posing a diagnostic challenge. This review is based on clinical experience and the 2022 International Union of Immunological Societies classification. It includes four clinical cases and proposes a practical approach for the evaluation of adults. In the presence of suspected IEI, a stepwise laboratory approach is proposed to facilitate early detection and improve prognosis. Initial screening with basic immunological tests-including complete blood count, immunoglobulin and complement levels, and lymphocyte immunophenotyping-is emphasized. Confirmation of each IEI requires more specific testing, often involving molecular techniques.