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

Introduction: Bacteremia caused by Gram-negative bacilli places a substantial burden on healthcare systems, mainly due to antibiotic resistance and delays in administering appropriate antimicrobial treatment (AT). The aim of this study was to describe the implementation of a rapid detection test (RDT) for CTX-M Extended Spectrum Beta-Lactamase-producing Enterobacterales (ESBL-PE) bacteremia as a tool for Antimicrobial Stewardship (AMS) in a tertiary hospital in Spain.

Material and methods: A cross-sectional study was conducted on blood culture (BC) samples from adult patients (≥18 years) admitted to a tertiary hospital in Spain (January 2021-February 2024). BCs with confirmed Enterobacterales identification were included. An RDT was used to detect CTX-M ESBL from direct BC. The results were reported to the AMS team. Data from electronic medical records and our laboratory information system were analyzed to explore the utility of implementing an RDT as an AMS tool.

Results: A total of 250 BCs from 250 patients were included. Empiric antimicrobial treatment (EAT) had not been prescribed in 41/250 (16.4%) patients, but was appropriately initiated in 33/250 (13.2%) after notification of the RDT results. Among those already receiving EAT (209/250, 83.6%), inappropriate and appropriate actions in AT were observed in 18/250 (7.2%) and 191/250 (76.4%) patients, respectively. By the time routine AST results were available, 241 (96.4%) patients had received appropriate treatment.

Conclusions: This study demonstrated the real-world application of an RDT to detect CTX-M ESBL directly from BC in a tertiary hospital. Early reporting of CTX-M ESBL status in Enterobacterales bacteremia enabled physicians and AMS teams to optimize AT.

Objective: Real-world data on bictegravir/emtricitabine/tenofovir alafenamide (BIC/FTC/TAF) fixed-dose combination from resource-constrained settings like Latin America are limited.

Methods: We conducted an observational retrospective cohort study of treatment-naive (TN, n=315) and treatment-experienced (TE, n= 2356) people living with HIV prescribed BIC/FTC/TAF in Argentina from 10/2019 to 12/2021, with 24 and 48-week follow-up data analyzed for virological suppression, persistence, safety, and metabolic parameters. Patient-reported outcomes were assessed via across-sectional online survey.

Results: Baseline characteristics: median age 45 years, 72.2% male, 99.6% Hispanic/Latino ethnicity. Treatment per sistence at 48 weeks was 99.3% (TN) and 99.5% (TE). Virological suppression rates (<200/<50 copies/mL) at 24 weeks were 97.4/88% (TN) and 99/97% (TE). At 48 weeks were 100/92% (TN) and 99/97% (TE). In the TE group, triglycerides decreased with no other lipid changes. In TN, mild total/LDL/HDL cholesterol increases occurred. eGFR mildly decreased in both groups. The online survey (n=536) showed 91.5% reported no medication concerns. Median quality of life scores were 90 (TN) and 88 (TE). Most reported no self-care, activity, mobility, pain/discomfort, or anxiety/depression issues.

Conclusions: BIC/FTC/TAF demonstrated high persistence, safety, virological efficacy, and favorable metabolic profile over 48 weeks. The cross-sectional survey indicated high treatment satisfaction and good quality of life in this cohort from Argentina.

Time to positivity (TTP) refers to the duration required for a microbiological culture test to indicate a positive result, marking the onset of detectable bacterial or fungal growth in the sample. Numerous variables, including patient characteristics, infection source, former antimicrobial therapy, blood sample volume, and sample transportation time can influence the value of TTP. Several studies have been conducted on bloodstream infections, whereas studies on the clinical significance of yeast TTP are quite limited in the literature. Furthermore, many studies are retrospective and have a small sample size. In this opinion paper, we have formulated some questions and attempted to provide answers based on the available literature and our perspective. The objective of this opinion paper is to summarise current knowledge based on the literature, aiming to offer a critical perspective, particularly on aspects with weaker evidence, which could guide future studies in this area. We believe that TTP of blood cultures appears to exhibit considerable potential and may prove to be a valuable tool in clinical practice for estimating patient mortality risk and guiding antimicrobial therapy choices. Topics discussed include the diagnostic and prognostic role of TTP in Gram-positive and Gram-negative bacteremias and in candidemias, and the significance of differential time to positivity (DTTP). In summary, our opinion is that, based on the available literature, it is not possible to determine whether TTP provides prognostic information, particularly concerning candidemia. Therefore, clinical decisions cannot be systematically based on this parameter.

Objective: To estimate the incidence of urinary tract infections (UTI) in elderly patients in Spanish emergency departments (ED), the need for hospitalization, diagnostic confirmation in hospitalized patients, adverse events and the predictive capacity of several biomarkers.

Methods: In this a posteriori substudy of a generic study of reasons for ED visits in elderly patients, we included patients aged ≥65 years seen in 52 Spanish EDs for 1 week, selecting those diagnosed with UTI. As adverse events, in-hospital and 30-day mortality and combined adverse event (death or hospitalization) at 30 days post-discharge were collected. Relative risks (RR) were calculated. The predictive capacity of 10 variables and 6 biomarkers was investigated.

Results: A total of 25,375 patients were included, 1058 with UTI (annual incidence: 24.7 per 1000 inhabitants aged ≥65 years and year, 95%CI: 24.5-24.9). A total of 36.5% were hospitalized, and in 80% the diagnosis of UTI was confirmed at discharge. Overall 30-day mortality was 5.4% and in-hospital mortality was 3.4%. Functional dependence was associated with both events (RR:2.91;1.18-7.17 and RR:12.61;1.47-108.11, respectively), as was having a CRP greater than 100 mg/L (RR:2.24;1.17-4.30 and RR:3.21;1.37-7.51, respectively). The combined post-high event occurred in 10.6%, and was associated with functional dependence (RR:2.05;1.04-4.06). CRP and hemoglobin had significant value in predicting 30-day post-discharge mortality or hospitalization.

Conclusions: UTI is a frequent diagnosis in elderly patients consulting in the ED. Functional dependence is the best factor associated with adverse events. The biomarkers analyzed do not have a good predictive capacity.

Objective: Escherichia coli is isolated in most of uncomplicated community-acquired urinary tract infections (UTI) and fosfomycin is one of the treatments of choice. We analyzed the evolution of fosfomycin resistance in extrahospitalary E. coli urinary isolates and whether age and extended spectrum beta-lactamase (ESBL) production were associated to antibiotic resistance.

Methods: A retrospective descriptive study was conducted from January 2017 to December 2022 including E. coli isolates from extrahospitalary urine samples.

Results: The susceptibility to fosfomycin remained above 95% during the study period. ESBL production and age above 80 years were significantly associated with increased fosfomycin resistance. We also analyzed the consumption of fosfomycin and it remained stable, although it was higher in the population >65 years.

Conclusions: Greater resistance is observed in ESBL-producing strains and in patients over 65 years of age. A stable consumption of fosfomycin is associated with low resistance percentages maintained over the time.

Objective: Anaerobic bacteremia represents 0.5-12% of all bacteremias and its mortality is high, ranging from 25-44%. The aim was to know our data to compare them with existing data and demonstrate the importance of actively searching for these microorganisms in blood culture samples.

Methods: A retrospective descriptive study in which the medical records of patients with significant episodes of anaerobic bacteremia were reviewed over a period of 8 years (2014-2022).

Results: A total of 59,898 blood cultures were processed, of which 10,451 were positive (17%). An anaerobic microorganism was identified in 209 patients. Anaerobic bacteremia accounted for 2.11% of the total number of positive blood cultures. The mean age was 63.55 years (17-96), 66% of whom were men. The origin was community in 63.64%, of nosocomial origin in 15.31% and associated with health care in 17.70%. The focus of infection was the abdominal (39.23%), followed by the respiratory (13.88%) and skin and soft tissues (13.39%). The most frequent comorbidities were: arterial hypertension (49.76%), dyslipidemia (29.67%), neoplasia (26.32%) and diabetes (26.32%). The main species isolated were the group Bacteroides spp. (44.50%) (n=93) highlighting Bacteroides group fragilis (n=65), followed by Clostridium spp. (20%) (n=42) highlighting Clostridium perfringens (n=30). The clinical evolution was good in 67.46%. The mean length of stay was 27.8 days and was associated with 20% mortality.

Conclusions: Bacteremias due to anaerobes represented 2.11% of the total number of true bacteremias, so we consider the active search for these microorganisms to be appropriate.

Clinical Decision Support Systems (CDSS) are computer-based tools that leverage the analysis of large volumes of health data to assist healthcare professionals in making clinical decisions, whether preventive, diagnostic, or therapeutic. This review examines the impact of CDSS on clinical practice, highlighting both their potential benefits and their limitations and challenges. We detail the experience of clinical medical professionals in the development of a virtual control center for COVID-19 patients (C3 COVID-19) in Spain during the SARS-CoV-2 pandemic. This tool enabled real-time monitoring of clinical data for hospitalized COVID-19 patients, optimizing personalized and informed medical decision-making. CDSS can offer significant advantages, such as improving the quality of inpatient care, promoting evidence-based clinical and therapeutic decision-making, facilitating treatment personalization, and enhancing healthcare system efficiency and productivity. However, the implementation of CDSS presents challenges, including the need for physicians to become familiar with the systems and software, and the necessity for ongoing updates and technical support of the systems.