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

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.

Introduction: Excessive duration of antibiotic treatment is associated with adverse events without improving clinical outcomes. The Emergency Department (ED) is a strategic location to implement Antibiotic Stewardship Programs (ASP). Our objective was to determine the effect of ASP recommendations on short antibiotic treatment regimens in patients with uncomplicated infections treated in the ED.

Material and methods: We conducted a quasi-experimental study comparing patients treated in the ED in September and October 2022 who were discharged with antibiotic treatment (control group) with those treated in November and December of the same year (intervention group). Recommendations regarding the appropriateness of antibiotic therapy were made in both groups, and regarding treatment duration only in the intervention group. A 30-day follow-up was performed to assess healing, readmissions due to infection, and adverse effects.

Results: A total of 78 patients were included, 40 in the control group and 38 in the intervention group. The median duration of antibiotic treatment was significantly shorter in the intervention group (7.5 days, IQR: 7-10 vs 6 days, IQR: 5-7, p<0.001). Healing rates were similar in both groups (92.5% vs 97.4%, p = 0.616). Adverse effects were documented in 7 patients from the intervention group (18.4%).

Conclusions: An ASP in the ED can shorten the duration of antibiotic treatment in patients with uncomplicated infections who are discharged, without affecting clinical outcomes, and without being associated with severe adverse effects, mortality, or readmissions due to infection.

We report the case of a 46-year-old woman with psoriatic arthritis treated with methotrexate and prednisone, candidate for certolizumab. Prior to starting the biologic, latent tuberculosis infection was diagnosed by a positive Mantoux test (6 mm) and normal chest imaging. Rifampicin 600 mg/day plus isoniazid + pyridoxine 300/50 mg/day were initiated for three months. After one month, certolizumab was started, and a decrease in neutrophils from 2.8 to 1.7 × 10⁹/L was observed; 15 days later, severe neutropenia (0.3 × 10⁹/L) developed. Rifampicin and isoniazid were discontinued, while certolizumab was maintained; the neutrophil count recovered to 0.8 × 10⁹/L within one week and normalized after one month. Subsequently, isoniazid monotherapy (nine months) was reintroduced without recurrence. According to the modified Karch-Lasagna algorithm, the rifampicin-neutropenia relationship was classified as probable (score 6). Drug-induced neutropenia from antituberculous agents is rare (<1%) but potentially serious. The chronology, reversibility after withdrawal, and tolerance to isoniazid suggest rifampicin as the causative agent. This case highlights the need to monitor the complete blood count, in addition to liver transaminases, at least during the first month of treatment of latent tuberculosis infection with rifampicin, especially in patients with risk factors, in order to detect hematological alterations early and prevent progression to agranulocytosis.

Objectives: To analyze how the increased frequency of meetings held by the Antimicrobial Stewardship Program (PROA) groupduring which non-mandatory, supportive prescription audits were conductedimpacted antimicrobial use, using hospital antimicrobial consumption-based indicators. To compare these results with those of other centers of similar complexity.

Materials and methods: A retrospective cohort study comparing antimicrobial use through hospital antimicrobial consumption-based indicators in 2023 (the first year the PROA team met twice per week) with 2022 (the last year the PROA team met once per week). The comparison with other centers was carried out using the antimicrobial hospital consumption platform of the Pharmaceutical Care Group for Infectious Diseases of the Spanish Society of Hospital Pharmacy.

Results: In 2023 compared to 2022, improvements were observed in 7 out of the 13 indicators: overall consumption of systemic antifungals, carbapenem consumption, metronidazole/piperacillin-tazobactam + carbapenem ratio, fosfomycin consumption, anti-MSSA/anti-MRSA agent ratio, amoxicillin-clavulanate/piperacillin-tazobactam ratio, and fluconazole/echinocandin ratio. In 2023, our hospital ranked above the 50th percentile in 7 out of the 13 indicators.

Conclusions: The increased frequency of PROA team meetings may be associated with partial improvements in antimicrobial use, according to hospital antimicrobial consumption-based indicators.