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

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.

Introduction: Carbapenem-resistant gram-negative bacilli (CRGNB) are one of the main causes of nosocomial infections, posing a major public health challenge. Blood stream infections (BSI) require special attention because of the higher morbidity and mortality associated.

Objective: To assess the impact of initial adequate or inadequate antibiotic treatment on the length of stay (LOS) and healthcare resource utilisation of patients with bloodstream infections (BSI) caused by a Carbapenem-resistant gram-negative bacilli (CRGNB) in the Spanish clinical practice.

Methods: A descriptive, observational, retrospective chart review study of patients diagnosed with CRGNB bacteriemia in 6 Spanish public hospitals.

Results: The overall median LOS of the total population (n=64) was 26.5 days (Q1: 16 days; Q3: 40 days). The median LOS for the initially adequately treated group was 27 days (Q1: 17; Q3: 50), and 24 days (Q1: 15; Q3: 38) for the initially inadequately treated (t-test p= 0.5031). In the Hospital Ward group (n=44), initially adequately treated patients spent hospitalised a median of 6 days less than the initially inadequately treated patients (18 days [Q1: 12; Q3: 27] vs 24 days [Q1: 15; Q3: 38] respectively, p=0.0269). In the total population analysis, initially adequately treated patients had a lower use of resources (20,895.02 [Q1: 11,543.67 ; Q3: 61,773.17 ]) compared to initially inadequately treated patients (24,444.02 [Q1: 11,571.63 ; Q3: 40,790.64 ).

Conclusion: Results suggest that inadequate empirical treatment for BSI caused by CRGNB in the hospital ward could be associated with an increase in the LOS and resource utilization of these patients.

Human infections by Bordetella bronchiseptica are increasing in recent years. However, due to the lack of clinical susceptibility/resistance breakpoints, antimicrobial treatment is complex. Business Intelligence (BI) is a tool that allows to record and analyze large amounts of data in a very short time. The aim of this study was to analyze a cohort of patients with B. bronchiseptica infections focusing on how BI can help guide empirical antimicrobial therapy Demographic, clinical, and microbiological data about B. bronchiseptica infections were recovered. Then, MIC_50/90 of several antibiotics was automatically calculated through the BI. Thirteen B. bronchiseptica infections were identified. The lowest MICs₉₀ were for carbapenem, aminoglycoside, fluoroquinolones, and tetracyclines. The EUCAST PK-PD (non-species related) breakpoints showed that only piperacillin/tazobactam, imipenem and meropenem would be appropriate treatments to use empirically. In conclusion, BI systems have great potential to optimize the empirical antibiotic treatment in these types of infections.

Introduction: Community-acquired methicillin-resistant Staphylococcus aureus (MRSA) is a human skin and mucosa colonizer being this colonization a risk factor for infections by this germ. It's unknown the role that domestic canines and felines (CF) play in human colonization. The objective of this study was to demonstrate the association between MRSA isolation in clinical samples from skin and soft tissue infections (SSTIs) in adults living with CF.

Material and methods: A retrospective model of cases (SSTIs with isolation of MRSA) and controls (SSTIs without isolation of MRSA) was used. We included 166 SSTI episodes treated in two hospitals, in Buenos Aires, Argentina, between October 2014 and January 2018. Samples were taken by puncture through healthy skin and the material obtained was sown in usual culture media. For bacterial identification, mass spectrometry and automated nephelometry were used. Methicillin-resistance was confirmed by disc-diffusion with cefoxitin discs. Data on living habits with CF and classic risk factors for SSTIs by MRSA were collected.

Results: Patients with SSTIs due to MRSA live more with CF (crude OR 1.9; [1.1-3.7] p<0.05) and tend to live more closely with them (crude OR 1.8; [0.99-3.43] p=0.08). In the multivariate analysis, those who live closely with CF have 1.3 times more chances of SSTIs due to MRSA (adjusted OR 2.32; [1.12-4.78] p<0.02).

Conclusions: We conclude that there is an association between human MRSA SSTIs and living with CF.

Introduction: The increased risk of tuberculosis (TB) reactivation in solid organ transplant recipients supports the recommendation of screening for latent tuberculosis infection (LTBI). Adherence to available screening tests has not been studied in the kidney transplant (KT) population. We aimed to assess screening compliance within the ATALANTA-DOS population study.

Methods: ATALANTA-DOS studied an intervention bundle aimed at preventing infection in KT recipients. We compared LTBI screening rates between the pre-intervention (February 2016 - September 2017) and intervention (February 2018 - September 2019) cohorts and evaluated adherence rates between the interferon-gamma release assay (IGRA) and the tuberculin skin test (TST).

Results: A total of 307 KT recipients were included (155 in the pre-intervention cohort; 148 in the intervention cohort). A systematic assessment of screening compliance by an infectious disease specialist on day +30 post-KT improved LTBI screening adherence (82.6% [114/138] vs 1.3% [2/155]; p-value <0.001). In the intervention cohort, compliance was higher with IGRA (83.3% [52/62]) than with TST (68.1% [49/72]). Two cases of LTBI were detected in the pre-intervention cohort and five in the intervention cohort (4.4% [5/114]). All patients completed LTBI treatment after ruling out active TB. No cases of active TB were identified during follow-up.

Conclusions: Systematic evaluation of LTBI screening compliance significantly increased screening completion rates among KT recipients. IGRA-based strategies increased screening compliance, supporting their implementation over TST for LTBI screening among KT recipients. Increased adherence would allow a more targeted and effective treatment of LTBI.

Introduction: To analyse the concordance between theoretical and actual stratification of people living with HIV infection attending a pharmaceutical care outpatient clinic in a tertiary regional hospital.

Material and methods: Observational, retrospective, analytical, cross-sectional and single-centre study in people living with HIV infection. Study period: April 2024. Inclusion criteria: patients with HIV infection aged over 18 years who had been receiving active antiretroviral therapy (ART) for at least two years prior to inclusion. The 2022 version of the pharmaceutical care stratification model for people living with HIV infection was used. Reliability was evaluated from a qualitative perspective using Cohen's Kappa coefficient.

Results: Of the 199 patients attended during the study period, 100 were consecutively selected, of whom 93 were ultimately stratified. Men accounted for 77.41% of the cohort, with a mean age of 47.81 ± 12.53 years. The obtained stratification percentages were: Priority 1: 7.52%; Priority 2: 26.88%; Priority 3: 65.59%. Quantitative analysis of concordance between the models yielded a Cohen Kappa value of K=0.866.

Conclusions: There is a good concordance between the distribution percentages of the theoretical stratification and the actual one obtained in our study.