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

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.

Introduction: Pseudoglutamicibacter cumminsii is an aerobic, Gram-positive coryneform bacterium whose clinical relevance has not yet been clearly established. Although an increasing number of isolates have been documented in clinical settings, its role in human pathogenesis remains uncertain and warrants further characterization.

Methods: We retrospectively analyzed 116 P. cumminsii isolates obtained from symptomatic outpatients in the Rhine-Ruhr metropolitan area (Germany) between January 2021 and February 2023. Clinical and demographic data, specimen types, and co-isolated organisms were recorded. Antimicrobial susceptibility testing (AST) was performed using broth microdilution, and results were interpreted according to EUCAST guidelines.

Results: Most isolates were recovered from urine (58.6%) and wound swabs (30.2%), primarily from older adults. A statistically significant association was found between specimen type and patient sex and age. While P. cumminsii was usually detected in polymicrobial cultures (75%), two pure-culture cases were identified: one in urine and one in synovial fluid. AST revealed high susceptibility to beta-lactams and linezolid, with variable response to fluoroquinolones.

Conclusions: P. cumminsii is a rare opportunistic pathogen with potential clinical relevance in urogenital and wound infections. Its low pathogenicity suggests it is more likely a secondary colonizer or commensal. Further studies are needed to better understand its clinical significance and impact on human health.

Acute infectious diarrhea is a major global health issue, especially in children, as gastrointestinal infections are the second most common infectious disease after respiratory infections. The implementation of rapid multiplex molecular syndromic panels (RMMSP) for the comprehensive detection and identification of enteric pathogens in stool samples has enhanced diagnostic precision, supplementing-or, in some cases, replacing-traditional methodologies. This narrative, non-systematic review synthesized the available evidence on the clinical performance of gastrointestinal RMMSP up to December 31, 2024. On May 27, 2024, specialists in Pediatrics and Microbiology met to assess the use of RMMSP in pediatric gastrointestinal infection diagnosis. This review focused on RMMSP applicable to urgent management of infectious acute gastroenteritis (AGE), excluding those panels unsuitable for immediate diagnosis. RMMSP facilitated rapid pathogen detection in pediatric infectious AGE and have shown potential advantages over traditional microbiological methods, including a reduction in time to appropriate treatment. Their use appeared particularly useful in emergency and inpatient settings for inflammatory AGE, prolonged traveler's diarrhea, or cases at risk for complications. They were also considered for outpatient diagnosis in moderate/severe cases, chronic diarrhea, or immunocompromised patients. Within a diagnostic stewardship framework, current evidence suggests that RMMSP can contribute to minimizing unnecessary testing and hospitalizations, improving outbreak control, and optimizing antimicrobial use. However, further research is necessary to refine diagnostic workflows and ensure timely result delivery. This document evaluated key aspects regarding the application of RMMSP in pediatric infectious AGE, aiming to establish standardized protocols, support clinical decision-making, and facilitate optimal patient management.

Introduction: Carbapenemase-producing Enterobacteriaceae (CPE) of the New Delhi metallo-β-lactamase (NDM) type are a growing public health concern due to their rapid dissemination, widespread antimicrobial resistance and associated increase in morbidity and mortality. The aim of this study was to describe the epidemiological characteristics of patients with NDM-type CPE (NDM-CPE) isolates.

Methods: A descriptive study of patients with at least one CPE-NDM isolate between December 1, 2022, and December 31, 2023. Demographic and clinical evolution data were collected from electronic medical records.

Results: NDM-CPE were identified in 77 patients, 87% of whom were adults and 75.3% were male. Thirty-two-point five percent were immunosuppressed. A total of 84.4% required hospital admission (60% in ICU) and 66.2% underwent surgery. The median time between admission and the first microbiological isolation of NDM-CPE was 18 days (RIC: 4-32 days). The most frequent microorganism was Klebsiella pneumoniae (92.2%), followed by Escherichia coli (4.2%), and Citrobacter freundii (4.2%). A total of 58.4% carried genes coding for NDM and OXA-48 carbapenemases, 40.3% for only NDM, and 1.3% for NDM and VIM. A total of 45.5% were patients with positive colonization samples for NDM-CPE, of whom 31.4% developed infection. Overall mortality at study end was 24.7 %.

Conclusions: Early identification of carriers, strengthening epidemiological and molecular surveillance, and prompt implementation of control measures are essential to interrupt transmission chains and protect the most vulnerable patients.

Introduction: HIV is now considered a chronic disease due to advances in antiretroviral therapy (ART), which have improved survival but have also increased both comorbidities and polypharmacy. This underscores the need for personalized care strategies such as the Capacity-Motivation-Opportunity (CMO) model and patient stratification tools. This study aimed to identify the discrepancy between patient-perceived and actual care complexity in HIV-positive patients on ART, as assessed by a stratification tool.

Methods: A retrospective, observational study at Valme Hospital (April-June 2024) included HIV-positive patients aged over 18 years on stable ART, excluding clinical trial participants. Data collected included age, sex, route of HIV acquisition, viral load, CD4 count, AIDS stage, comorbidities, polypharmacy and the Medication Regimen Complexity Index (MRCI). Perceived complexity was assessed using a visual analogue scale, whereas complexity according to the stratification tool was calculated with the variables of the CMO model.

Results: A total of 411 participants with a median age of 55 years were included, of whom 72.5 % had comorbidities, primarily cardiovascular. The median MRCI score was 8, with 85.4 % of patients were classified at stratification level 3, while 74.9 % reported low perceived healthcare complexity. Concordance between stratification and perceived complexity was weak. Significant associations were observed between perceived complexity and AIDS stage, extensive polypharmacy, and stratification levels.

Conclusions: This study emphasises integrating objective assessments and patient perspectives to improve healthcare evaluation and patient-centered care.