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

In 2023, a monoclonal antibody (niservimab) specifically targeting the "zero site (Φ)" of the prefusion form of the RSV F protein was marketed in Spain. Various studies have demonstrated its high efficacy in preventing hospitalization and ICU admission in patients with RSV. However, the high cost of this monoclonal antibody, unaffordable in many developing countries, its inaccessibility, or religious beliefs may prevent its routine use in infants worldwide. Therefore, new treatment prospects have been explored through the development of low-cost, orally administered antiviral drugs that can be used anywhere, with or without the monoclonal antibody. In 2014, Ark Biosciences registered Roche's compound RO-0529 for clinical development and named it AK0529; in 2019, it was definitively designated ziresovir. This compound emerged from a program searching for RSV F protein inhibitors based on the benzoazepinequinoline compound. The data available to date suggest that ziresovir is a potent antiviral inhibitor of RSV F protein. When administered orally twice daily for 5 days, it produces a clear clinical improvement in bronchiolitis (signs and symptoms) and a decrease in viral load in the respiratory tract. This new antiviral is well tolerated with few adverse effects, but with the development of resistance during treatment in 11-18% of cases, especially at high doses.

Objectives: To develop and validate a clinical model to predict 30-day mortality in high-risk COVID-19 patients evaluated in the Emergency Department, and to evaluate outcomes in adults with COVID-19 pneumonia classified as low-risk by the model and discharged home.

Methods: Secondary analysis of the COVID-19_URG-HCSC registry at Hospital Clínico San Carlos (Madrid). Phase 1 (Feb-Apr 2020): derivation of a model in patients aged ≥18 years with probable or confirmed COVID-19 who were classified as high-risk at triage (age ≥55 years, baseline oxygen saturation <96% on arrival, or pulmonary infiltrates on chest radiograph). The primary outcome was 30-day all-cause mortality. Phase 2 (Sep 2020-May 2021): validation in adults with low-risk pneumonia discharged home and monitored by telephone. Primary outcomes were 30-day all-cause mortality, revisits, and hospitalization.

Results: Of 2,436 eligible patients in phase 1, age, oxygen saturation, renal function, LDH, CRP, platelet count and dementia were independent mortality predictors. The model showed excellent discrimination (AUC 0.918) and good calibration, and was implemented in a web-based tool. In phase 2, 565 patients with low-risk pneumonia were monitored; no deaths occurred at 30 days. Re-attendance was 8.0% and hospitalisation 12.6%, mainly for respiratory failure. All hospitalised patients were ultimately discharged home.

Conclusions: The PrediCOVID model provides accurate risk stratification and, when combined with telemonitoring, enables safe early discharges while reducing hospital burden.

Intra-abdominal candidiasis, which includes Candida peritonitis and Candida produced intra-abdominal abscesses, accounts for 10-30% of all intra-abdominal infections diagnosed in the intensive care units. Intra-abdominal candidiasis is associated with longer hospital stay, and significantly higher morbidity and mortality. Although the management of invasive candidiasis has greatly improved in these past years, the optimal management of intra-abdominal candidiasis remains elusive. Questions concerning the microbiological diagnosis, optimal antifungal drugs doses, diffusion through peritoneal fluid, and the value of liposomal amphotericin B as first-line treatment, remain unanswered. In this article, three important issues concerning intraabdominal candidiasis have been re-viewed: microbiological diagnosis and risk of antifungal resistance emergence, pharmacokinetic/pharmacodynamic particularities of antifungals, and clinical management on the daily practice. Only an optimized multidisciplinary approach combining rapid diagnostics, tailored antifungal therapy, and effective source control will improve the management and prognosis of patients with intra-abdominal candidiasis.

Respiratory syncytial virus (RSV) infection is one of the main causes of morbidity and mortality in infants under 6 months of age; however, it can cause respiratory infection at other stages of life. In the period 2018-2025, the number of cases has risen considerably, with positivity mainly concentrated in children under 24 months of age. The SARS-CoV2 pandemic caused modifications in affected population groups and seasonality. The percentage of RSV in children under 6 months of age in the period 2024-2025 was significantly lower than in the 2023-2024 season. In contrast, in the elderly population, especially those over 86 years of age, the percentage of positive cases has increased significantly. From 2022 onwards, the incidence of virus positivity shows a more stable and sustained pattern from October to April compared to previous years. The aim of this review is to assess the evolution of the type of patient diagnosed with RSV infection and to determine early whether the beginning of the vaccination campaign has reduced the incidence in the susceptible population. The availability of epidemiological information to guide decision-making is of great importance for evaluating the effectiveness of these measures and adopting changes in the use of vaccination in the general population.

Acute respiratory infections (ARIs) are one of the main causes of morbidity, functional impairment, and mortality in institutionalised older adults. This group is highly vulnerable due to factors such as advanced age, multimorbidity, frailty, and structural barriers to infection prevention and control. This article reviews, in a question-and-answer format, the most recent evidence on the epidemiology, prevention and treatment of the most relevant respiratory infections in nursing homes: influenza, SARS-CoV-2, respiratory syncytial virus, and Streptococcus pneumoniae. Epidemiological changes after the COVID-19 pandemic, current vaccination strategies, the efficacy and characteristics of newly vaccines available, as well as the updated therapeutic approach according to resistance profiles and the availability of antivirals, are analysed. In addition, the clinical and functional impact that these infections can have on residents is addressed, as well as the need to find a balance between preventive measures and the quality of life of this population group. The importance of effective coordination between health and social care professionals, and the implementation of protocols adapted to the residential context is highlighted. The article provides practical, evidence-based recommendations to improve the prevention and treatment of these infections in a particularly vulnerable environment.

Background: Postsurgical mediastinitis (PSM) is a serious and potentially life-threatening complication of Major Heart Surgery (MHS). Data on the evolution of the incidence of PSM after MHS in large series of operated patients in recent years are scarce. The aim of our study was to evaluate the trend of incidence, microbial etiology, and associated mortality of PSM at a referral MHS unit in the last 12 years.

Material and methods: The study was conducted at a tertiary hospital in Madrid, Spain. We carried out a retrospective and cross-sectional study that included all patients who underwent CCM and developed MPQ between January 2012 and December 2023 at our institution. It was conducted at a tertiary hospital in Madrid, Spain. We carried out a retrospective and cross-sectional study that included all patients who underwent CCM and developed MPQ between January 2012 and December 2023 at our institution.

Results: During the 12-year study period, a total of 5,584 patients underwent MHS at our institution. The incidence rate of PSM varied yearly between 1.16 and 2.34 episodes/100 surgical procedures. Overall, the 89 patients with PSM were analyzed (92 different episodes). Their median age was 67 years (IQR 56-75) and most of them were male (63%). Their median Euroscore was 7 (IQR 5-9.5). Main type of heart surgery in patients with PSM was: coronary artery bypass graft in 37% and valve replacement in 32.6%. The more frequent causative microorganisms were: Gram-positive bacteria (59.0%), Gram-negative bacteria (32.4%), fungi (7.6%) and others (1%). Overall, 22 patients died (24.7%).

Conclusions: The incidence of PSM has remained stable and below 2.5% in the last 12 years in our institution, but it continues to be an entity associated with high morbidity and mortality and long hospital stays.

Introduction: Dolutegravir plus lamivudine (DTG/3TC) dual therapy has demonstrated efficacy in HIV treatment, but access remains challenging in Latin America. Argentina approved a generic co-packaged DTG+3TC presentation to improve accessibility. This study evaluated the effectiveness and safety of co-packed DTG/3TC compared to DTG-based triple therapy in clinical practice.

Materials and methods: A retrospective observational cohort study conducted between October 2019 and November 2023 at a reference HIV center in Argentina. Treatment-experienced people living with HIV (PLWH) with viral suppression who switched to either co-packaged DTG/3TC or DTG-based triple therapy were included. Primary outcomes included persistence, virologic suppression rates (VSR), and safety at 6, 12, and 18 months.

Results: Of 599 PLWH, 245 (41%) switched to dual therapy and 354 (59%) to triple therapy. Persistence rates for dual therapy at 6, 12, and 18 months were 99%, 100% and 98%; for triple therapy: 99%, 97% and 97%, respectively. VSR for dual therapy were 99%, 98% and 99%; for triple therapy: 99%, 97% and 98% at the same timepoints. Adverse event rates were low in both groups: dual therapy (0.5%, 0%, 0.8% at 6, 12, 18 months) and triple therapy (1.2%, 0.7%, 0.4% at 6, 12, 18 months).

Conclusions: Co-packaged DTG/3TC demonstrated high persistence and virologic suppression rates with a favorable safety profile in clinical practice. Its effectiveness and safety were comparable to DTG-based triple therapy, supporting its use as a cost-effective alternative for treatment-experienced PLWH in resource-limited settings.