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

The timely and appropriate administration of empirical antibiotic therapy is critical for patient survival. However, several studies suggest that approximately 20-30% of patients presenting with sepsis receive inadequate antibiotic treatment, a factor strongly associated with increased mortality. Furthermore, approximately 20% of these patients experience adverse effects. The emergence of multidrug-resistant bacteria has significantly complicated the selection of appropriate antibiotic therapy and contributed to increased mortality. This challenge is particularly pronounced in conditions such as ventilator-associated pneumonia and bacteremia of various origins, which represent some of the most common infectious pathologies in the intensive care unit. This has resulted in the development of a range of rapid diagnostic tools, including syndromic panels. The primary objective of these panels is to identify the causative agent of infection at an early stage and to guide the selection of the optimal treatment as quickly as possible.

The treatment of infections caused by multidrug-resistant microorganisms (MDROs) in critically ill patients remains a major clinical challenge due to the high mortality associated with therapeutic failure. Delays in administering effective antibiotics is a determining factor, especially in patients with sepsis. The presence of MDROs is one of the main causes of failure of empirical treatment. Identifying patients at risk of MDRO infection is essential, although complex. Factors such as prior use of antibiotics disrupt the intestinal microbiome balance and promote colonization by MDROs. Immunosuppression, disruption of physical barrier, systemic or organ-specific frailty, and the length of hospital stay increase the risk of colonization and infection by MDROs. In patients with sepsis and a high risk of MDRO infection, empirical therapy should be broad-spectrum and administered early. Traditionally, combination therapy has been recommended, preferably including a classical β-lactam together with aminoglycosides or colistin-drugs that may be suboptimal in certain infection sites and are associated with significant toxicity risks. The new broad-spectrum β-lactams, already validated as first-line targeted treatment, are emerging as a promising empirical option in selected patients. Their early use, guided by colonization status, can optimize initial coverage in terms of spectrum and pharmacokinetic/pharmacodynamic, and reduces delays in the initiation of effective treatment. This strategy should be integrated into antimicrobial stewardship programs and be followed by deescalation once microbiological results are available.

Sepsis remains a major cause of morbidity and mortality and continues to pose substantial diagnostic challenges in its early stages. Monocyte Distribution Width (MDW), a parameter automatically integrated into complete blood counts by next-generation haematology analysers, has emerged as a promising biomarker. This study evaluates the diagnostic performance of MDW compared with traditional markers (C-reactive protein and leukocyte count) and clinical scoring systems (SOFA and NEWS) in a cohort of critically ill patients presenting to a hospital emergency department, with the aim of distinguishing those with infection from those whose severity was attributable to other causes.

Invasive fungal infections are a major cause of morbidity and mortality in critically ill patients, with an increasing global incidence and species diversity, especially after the SARS-CoV-2 pandemic. Diagnosis relies on a combination of classical methods (microscopy, culture) and non-classical tools including biomarkers (1,3-β-D-glucan, galactomannan, mannan) and molecular assays. Fungal infections (candidiasis, aspergillosis, pneumocystosis, and mucormycosis) requires tailored diagnostic strategies based on host risk factors, epidemiology and specimen type. Combining diagnostic tests improves sensitivity and negative predictive value, guiding timely antifungal treatment. An integrated, pathogen-specific approach is essential to improve outcomes in the critical ill patient.

Cytomegalovirus (CMV) infection is a leading cause of morbidity and mortality among immunocompromised individuals, especially hematopoietic stem cell transplant and solid organ transplant recipients. In recent years, significant advances have transformed the approach to CMV prevention and therapy. This manuscript explores key evidence regarding antiviral prophylaxis, treatment strategies, resistance mechanisms, and the potential of immune-guided monitoring in transplant settings. The role of novel agents such as letermovir and maribavir is highlighted. These findings support personalized strategies that balance efficacy, toxicity, and resistance in managing CMV infection.

This manuscript summarizes the most relevant publications and international conference presentations on HIV infection between 2022 and 2024. It provides updated epidemiological data on HIV in Spain and assesses healthcare professionals' knowledge regarding HIV transmission and prevention. It also discusses the REPRIEVE study, given its significant clinical implications for the management of people living with HIV. In addition, it reviews recent advances in antiretroviral therapy and pre-exposure prophylaxis, focusing on dual therapy regimens and long-acting injectable treatments, due to their significant clinical impact on the management of people living with HIV.

Suboptimal antimicrobial use is a global challenge driven by entrenched misconceptions and dogmas. This article aims to critically evaluate and debunk several widespread myths in infectious disease management that lead to overdiagnosis and overtreatment. Through a nonsystematic literature review, this manuscript examines key misconceptions across various aspects of antimicrobial therapy, including administration routes, drug mechanisms, treatment duration, and the interplay with infection source control. It also explores the influence of evolving concepts like long-acting antimicrobials and the human microbiome. We challenge the dogmas that intravenous antibiotics are superior to oral agents, that longer courses are always better, and that bactericidal drugs are more effective than bacteriostatic ones. The review highlights the paramount importance of source control and surgical intervention in treating severe infections and cautions against misinformation surrounding the human microbiome. The medical community must critically re-evaluate long-standing clinical practices to improve antibiotic stewardship. By debunking these myths, we can promote a more precise, safe, and effective approach to antimicrobial use, ultimately reducing unnecessary prescribing and combating antimicrobial resistance.

This non-exhaustive minireview describes the main characteristics of the new beta-lactamase inhibitors (enmetazobactam, avibactam, relebactam, durlobactam, zidebactam, nacubactam, vaborbactam, taniborbactam, and xeruborbactam), their spectrum of inhibition, their activity in combination with different beta-lactams, the main resistance mechanisms that can compromise their activity and the main applications of the different beta-lactam-beta-lactamase inhibitor combinations depending on the type of beta-lactamase/carbapenemase and the microorganism involved.

This document focuses on the different aspects to be considered in order to improve the management of nosocomial peritonitis, particularly the changes in the epidemiology of causative microorganisms and the increasing emergence of pathogens resistant to commonly used antimicrobials. To facilitate their identification and treatment, the latest advances in microbiological diagnosis and evidence on the efficacy of new antimicrobial alternatives against resistant microorganisms are presented. All these factors, together with measures aimed at reducing treatment duration, also addressed in this document, will be analyzed in depth in a second paper to be published shortly.