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

Objective: One of the main problems with Clostridioides difficile infection (CDI) is its tendency to recur. The objective of the study is to analyze which factors in the clinical management of CDI favor recurrence.

Methods: This is a retrospective study conducted at the Hospital Universitario Príncipe de Asturias on cases of CDI between January 2021 and June 2023. Demographic variables, comorbidities, risk factors for recurrence, and treatments used for CDI were recorded. Non-optimal clinical management was defined as: not discontinuing treatment with proton pump inhibitors (PPIs) if the patient was on them, not discontinuing concomitant antibiotic treatments if the patient was on these, the use of metronidazole monotherapy in any case, or the use of standard-dose vancomycin if there were risk factors for recurrence.

Results: A total of 327 cases were found in 256 patients. 69 patients died within 8 weeks after the episode (26.9%). Among the remaining 258 episodes, there were 68 recurrences (26.3%). Of these 68 recurrences, 63 cases received nonoptimal treatment (93.2%), compared to 112/190 (58.9%) among those who did not recur. In the multivariate analysis adjusted for confounding factors, patients who received optimal treatment had an 89% lower risk of recurrence compared to those who did not receive it (OR 0.1; p < 0.001).

Conclusions: Reducing the use of PPIs and antibiotics and prioritizing more effective treatments against CDI could improve the recurrence rates of this infection.

Objective: Prior research has not examined the size of antibiotic packages prescribed. We assessed 2023 prescription rates in Barcelona and the most prescribed presentations in pharmacies, while evaluating potential reductions if all amoxicillin and amoxicillin/clavulanate containers had 20 doses.

Methods: Antibiotics prescribed by primary care doctors working for the Catalonian Health Institute in Barcelona in 2023 were analysed by calculating the defined daily doses per 1,000 inhabitants and day (DID).

Results: The observed prescribing rate was 8 DID, with penicillins accounting for 4.6 DID (57.2%). The most frequently prescribed antibiotics were amoxicillin and amoxicillin/clavulanate, making up 4.4 DID. If all the 30-dose presentations of amoxicillin and amoxicillin/clavulanate had been 20-dose containers, the total number of DIDs would have been 3.3, resulting in a reduction of 1.1 DID (25.4% less).

Conclusions: Antibiotic prescribing rate in Barcelona was low. Aligning the dosage of antibiotics with established guidelines could further reduce antibiotic consumption.

Objective: Respiratory syncytial virus (RSV) bronchiolitis is the leading cause of hospitalization in infants. This season, a long half-life monoclonal antibody (Nirsevimab) is available to prevent this disease for all infants born from 1 April-30 September to 2023 and all those born during RSV season (October2023- March 2024). The aim of this study was to evaluate the impact of the implementation of this antibody on RSV admissions in a tertiary hospital.

Methods: Observational, retrospective and analytical study. All patients <6 months in October admitted for bronchiolitis at 2 time points were included: T1 or Pre-nirsevimab time: 1 September 2015-30 September 2023 and T2 or Nirsevimab time: 1 October-31 December 2023. Total admissions due to any cause of infants <6 months in the same period were used as the reference population. To assess the impact of the implementation of nirsevimab, we calculated the reduction in the percentage of admissions due to RSV with respect to total admissions in both periods, and also in the 2023-2024 season we calculated the double negative test to calculate the effectiveness of the intervention (1-Odds ratio) x 100.

Results: In infants under 6 months of age, we found significant differences in the number of admissions for RSV bronchiolitis between the last season and the previous 7 seasons [574/1195 (48%) vs 6/138 (4.3%); p<0.01, RPI: 91%). In the 2023/2024 season, the effectiveness of nirsevimab in preventing admission for RSV bronchiolitis in children under 6 months of age was 85% (CI 95%: 32-97%).

Conclusions: The implementation of nirsevimab has had an important impact on the number of hospital admissions for RSV bronchiolitis. There were no differences in the severity of bronchiolitis.