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

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.

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.