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

Most evaluations of the burden of pneumonia in hospitalized patients are partial and concern specific subgroups of patients. However, few studies allow for the assessment of the global scope of the problem and the potential for intervention with guidance that could improve its diagnosis and treatment. This descriptive study conducted in a tertiary-care center aimed to determine the prevalence of pneumonia in hospitalized adults, to characterize its origins and etiology, and to evaluate the feasibility of a telematic intervention to advise on its diagnosis and treatment. A prevalence study was performed on the 653 adult inpatients admitted in July 2025. The pneumonia prevalence per 1,000 admitted patients was overall 36.8, community-acquired 24.5, nosocomial non-ventilator-associated 9.2, and nosocomial ventilator-associated 3.1. An etiological agent was identified in 29.2% of cases. In a critical review of the cases, opportunities to optimize either diagnosis or treatment were detected in 100% of pneumonia patients. After 30 days of dynamic follow-up of the selected cohort, overall mortality was 16.7%.

Introduction: Pneumococcal meningitis is a severe form of invasive pneumococcal disease (IPD). Despite the changes introduced by conjugate vaccines, pneumococcal meningitis remains a major clinical and public health challenge. Analyzing its current patterns allows the identification of serotypes that retain a higher invasive potential, the assessment of their relationship with clinical outcomes, and the guidance of future preventive strategies.

Methods: Retrospective descriptive study of patients with pneumococcal meningitis admitted between 2018 and 2024. Clinical, demographic, and microbiological variables were analyzed, including identified serotypes, markers of severity (ICU, intubation, death), vaccination status, and antimicrobial sensitivity.

Results: Thirty-six cases of pneumococcal meningitis were identified (8 pediatric, 28 adults), with a case fatality rate of 19.4% and an ICU admission rate of 69.4%. The serotype was identified in 88.9% of cases, with 17 different serotypes detected. The most aggressive serotypes were 8, 3, 16, 33, and 23B, and the most lethal were 8, 3, 23A, 25A, and 9N. Seventy-five percent of adults had an indication for vaccination, but only half had received any doses. Resistance to cefotaxime was documented in three strains (9N, 19A, 23F), one of which was associated with a fatal outcome.

Conclusion: Pneumococcal meningitis remains a serious condition. Serotypes such as 8 and 3 are associated with high mortality rates. Low vaccination coverage in at-risk groups represents a critical gap in prevention. Knowing the serotypes involved and their resistance profiles is key to adapting vaccination strategies and reducing the burden of this disease.

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.