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

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.

Objective: To evaluate how antimicrobial consumption was influenced by increasing the frequency of meetings in which the Antimicrobial Stewardship Program (ASP) team conducted prospective audit and feedback (PAF).

Materials and methods: Retrospective cohort study comparing consumption in DDD per 1000 beds-day and DDD per 1000 admissions across groups of anti-infectives, antibacterial groups, agents against methicillin-susceptible Staphylococcus aureus (anti-MSSA agents)/agents against methicillin-resistant Staphylococcus aureus (anti-MRSA agents), antibiotics targeting sensitive Gram-negative bacteria/antibiotics targeting resistant Gram-negative bacteria and antimicrobial agents, during two comparative periods of ASP activity (2 weekly meetings in 2023 versus 1 weekly meeting in 2022).

Results: Comparing 2023 to 2022: antibacterials for systemic use consumption increased in DDD per 1000 beds-day (+0.13%) and decreased in DDD per 1000 admissions (-3.55 %); consumption in DDD per 1000 beds-day and DDD per 1000 admissions increased for penicillins, glycopeptides and aminoglycosides while it decreased for cephalosporins and carbapenems, quinolones use increased per beds-days but decreased per admissions; regarding anti-MSSA and anti-MRSA agents, consumption of cefazolin, cloxacillin, vancomycin and daptomycin increased in DDD per 1000 beds-day and DDD per 1000 admissions, linezolid consumption increased per beds-day but decreased per admissions; for antibiotics targeting sensitive Gram-negative bacteria and antibiotics targeting resistant Gram-negative bacteria, consumption of amoxicillin-clavulanate, piperacillin-tazobactam, aminoglycosides, ceftazidime, cefepime and polymyxins increased per DDD/1000 bed-days and DDD per 1000 admissions, carbapenems consumption decreased per bed-days and admissions.

Conclusions: The increase in the frequency of meetings seems to be related to better use of antimicrobials in our center.

Objectives: To analyze and compare the accuracy of midregional proadrenomedullin (MR-proADM) to predict poor clinical outcome (understood as progression to septic shock or admission to the Critical Care Unit -CCU-) and 30-day mortality in adult patients seen for suspected infection in the Emergency Department (ED). We also compared their performance with other biomarkers (C-reactive protein -CRP-, procalcitonin -PCT-, lactate and leukocyte count) and clinical scales widely used in routine practice (qSOFA, SRIS, NEWS-2).

Methods: A prospective, observational and analytical study was carried out on adult patients who were treated in an ED with the clinical diagnosis of an infectious process. Follow-up was carried out for 30 days. The main outcome was a composite measure that included progression to septic shock or admission to the CCU and 30-day mortality. The predictive ability was analyzed with the area under the curve (AUC) of the receiver operating characteristic (ROC) and the values of sensitivity (Se), specificity (Sp), positive predictive value (PPV) and negative predictive value (NPV) of MR-proADM, PCR, PCT, lactate, leukocyte count and the clinical scales.

Results: 214 patients were included, of whom 31 (14.5%) fulfilled the combined variable. The mean age was 68.6 (SD 20.75) years, 55.1% (118) were men. The MR-proADM concentration achieved the best AUC-ROC of 0.920 (95% CI: 0.850-0.989) compared to the other biomarkers and clinical scales. With a cut-off point (Cp) according to the Youden index > 2.105 nmol/L, a Se: 68%, Es: 98% and NPV: 97% were obtained. The NEWS-2 scale ≥ 5 achieves an AUC-ROC of 0.733 (95% CI: 0.630-0.835) with a Se: 87%, Es: 55% and NPV: 96%. The mixed model (MR-proADM ≥2.1 nmol/l + NEWS-2 ≥5) improved the AUC-ROC to 0.849 (95% CI: 0.782-0.915) and Se: 68%, Es: 98%, PPV: 74% and NPV: 88%.

Conclusions: In adult patients attended with clinical suspicion of infection in the ED, MR-proADM presents a high ability to predict poor clinical evolution (progression to septic shock or ICU admission) and 30-day mortality and performs better than PCT, lactate, CRP, leukocyte count and the clinical scales qSOFA, SRIS, NEWS-2. The combined model (MR-proADM ≥2.1 nmol/L + NEWS-2 ≥5) improves prediction of both MR-proADM and clinical scales.

Introduction: Infective endocarditis (IE) is a complex condition associated with high morbidity and mortality. The creation of multidisciplinary teams (endocarditis team) has been shown to improve its management and prognosis. We analysed the impact of the formal implementation of a multidisciplinary IE committee (coIE) in a tertiary care hospital.

Methods: Single-centre quasi-experimental study comparing two periods: before (2010-2015) and after (2017-2021) the implementation of the coIE. The coIE met weekly (and on demand when necessary) to make decisions regarding medical and surgical management in patients with definite or possible IE, following a protocol based on international guidelines.

Results: We included 92 and 97 patients in the pre- and post-intervention periods, respectively. Demographic characteristics, predisposing factors, and types of IE were similar. No significant differences were observed in the proportion of patients with surgical indication who underwent surgery (30.2 % vs 39.1 %, respectively; p = 0.317), in-hospital mortality (27.2 % vs 34.0 %; p = 0.308), or one-year mortality (32.6 % vs 45.4 %; p = 0.073). The median (interquartile range) time from diagnosis to surgery decreased in the post-intervention period (11.5 [6.3-25.3] vs 7 [3-10] days; p = 0.026). The diagnosis of embolic events was more frequent in this period (46.7 % vs 58.8 %; p = 0.098).

Conclusions: Although we did not observe a significant impact on mortality among patients with definite IE after the implementation of an endocarditis team, we noted a favourable trend in intermediate indicators of healthcare quality.