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

Introduction: The incidence of coinfections and superinfections following SARS-CoV-2 pneumonia has garnered increasing attention, with complications arising from various pathogens, including viruses, bacteria, and fungi. Nevertheless, the relationship between COVID-19 and tuberculosis (TB) is not fully understood. This study investigates the incidence and risk factors for post-COVID-19 pulmonary TB in a low TB prevalence area in southeastern Spain, alongside the influence of COVID-19 on indeterminate results in the Quantiferon-TB Gold Plus (QFT-Plus) test and its prognostic role.

Material and methods: A retrospective cohort study was conducted involving 475 hospitalized COVID-19 from March 2020 to March 2022, all of them with a QFT-Plus performed.

Results: The study found three cases of pulmonary TB in the post-COVID-19 period, yielding an incidence density of 3.56 cases per 1000 patient-years, all associated with chronic systemic corticosteroid therapy. Notably, the percentage of indeterminate QFT-Plus results during COVID-19 was significantly higher than when it was performed before the disease (16.82% vs. 3.37%). Patients with indeterminate results exhibited elevated inflammatory markers and a greater need for invasive mechanical ventilation, correlating with more severe disease, although without statistical significance.

Conclusions: The findings suggest that prolonged systemic corticosteroid therapy is a common risk factor for pulmonary TB development and that systematic LTBI screening may not be necessary for all COVID-19 patients unless prolonged corticosteroid treatment is foreseen. This study highlights the need for further research to clarify the relationship between COVID-19 and post-COVID-19 pulmonary TB, as well as the prognostic implications of QFT-Plus results.

Introduction: To describe the epidemiology pattern of the COVID-19 pandemic during all Spanish State of Alarm.

Methods: Retrospective, observational, cohort and multicenter study. Inclusion criteria: age ≥18 years old, admitted for COVID-19 pneumonia in any of the centers of the HM Hospitals Group. Exclusion criteria: voluntary discharge, death in the emergency department, transfer to centers outside the HM group or incomplete data. State of Alarm period: 31/01/2020 to 05/07/2023. Predominant COVID-19 variant was defined when it exceeded 50% of the total isolates.

Results: During the study period, 2,992 patients were admitted due to a COVID-19 pneumonia, 295 patients (9.86%) non-survive. Survivors and non-survivors were different in age and comorbidities. However, both cohorts presented a similar net of interaction between comorbidities. Hospital admissions per week showed an evolution in "peaks" with "troughs". A total of 197 (6.48%) patients were admitted to the ICU, of whom 52 (26.39%) non-survive; this subgroup stood out for having a higher proportion of septic shock, orotracheal intubation and acute renal failure, as well as a lower proportion of pulmonary thromboembolism and delirium. Concerning the viral variants, the incidence for the original variant was 4.05 cases/day, for the alpha variant 3.82 cases/day, for the delta variant 1.16 cases/day and for the omicron variant 1.35 cases/day.

Conclusion: Almost 1 of 10 patients with COVID-19 pneumonia death, a proportion that increased to 1 of 4 in case of being admitted to the ICU. Unexpectedly, interaction between comorbidities did not differ between survivors and non-survivors patients. Predominant variants were associated with different hospital admission rates but not influence the presence of peak-troughs evolution of the pandemic.

Introduction: This study aims to describe antimicrobial use in primary care across Spain by analyzing the prescriptions dispensed in pharmacies. Antimicrobials were categorized into therapeutic action groups based on the ATC-2 classification: antibacterials (J01), antimycotics (J02), antimycobacterials (J04), and antivirals (J05). Additionally, the study explores epidemiological patterns of use.

Methods: A retrospective observational study was conducted using data from the Primary Care Clinical Database (BDCAP) for 2023. The analysis focused on defined daily doses (DDD) per 1,000 persons/day (DHD), and the number of individuals with at least one antimicrobial prescription in primary care. Data were stratified by age, sex, municipality size, income level, country of birth, and employment status. Changes in prescriptions percentages in 2017 and 2023, as well as variations by age group and sex were compared.

Results: An overall upward temporal trend in the antimicrobial DHD was observed from 2017 to 2023 (increase of 20.2%), with a decrease in usage during 2020 and 2021. Women exhibited higher DHD for antibacterials, antimycotics, and antivirals, whereas men demonstrated higher DHD for antimycobacterials. Notably, antimycobacterial agents had higher DHD in municipalities with populations exceeding 100,000 inhabitants and among foreign-born individuals. Out of 46,762,487 people assigned to primary care, 14,056,450 received prescribed antimicrobials in 2023.

Conclusions: These findings indicate a rising trend in antimicrobial use in primary care, underscoring the need for targeted interventions to encourage the rational use of antimicrobials, particularly in high-use groups.

Introduction: Bacteremia caused by Gram-negative bacilli places a substantial burden on healthcare systems, mainly due to antibiotic resistance and delays in administering appropriate antimicrobial treatment (AT). The aim of this study was to describe the implementation of a rapid detection test (RDT) for CTX-M Extended Spectrum Beta-Lactamase-producing Enterobacterales (ESBL-PE) bacteremia as a tool for Antimicrobial Stewardship (AMS) in a tertiary hospital in Spain.

Material and methods: A cross-sectional study was conducted on blood culture (BC) samples from adult patients (≥18 years) admitted to a tertiary hospital in Spain (January 2021-February 2024). BCs with confirmed Enterobacterales identification were included. An RDT was used to detect CTX-M ESBL from direct BC. The results were reported to the AMS team. Data from electronic medical records and our laboratory information system were analyzed to explore the utility of implementing an RDT as an AMS tool.

Results: A total of 250 BCs from 250 patients were included. Empiric antimicrobial treatment (EAT) had not been prescribed in 41/250 (16.4%) patients, but was appropriately initiated in 33/250 (13.2%) after notification of the RDT results. Among those already receiving EAT (209/250, 83.6%), inappropriate and appropriate actions in AT were observed in 18/250 (7.2%) and 191/250 (76.4%) patients, respectively. By the time routine AST results were available, 241 (96.4%) patients had received appropriate treatment.

Conclusions: This study demonstrated the real-world application of an RDT to detect CTX-M ESBL directly from BC in a tertiary hospital. Early reporting of CTX-M ESBL status in Enterobacterales bacteremia enabled physicians and AMS teams to optimize AT.

Objective: Real-world data on bictegravir/emtricitabine/tenofovir alafenamide (BIC/FTC/TAF) fixed-dose combination from resource-constrained settings like Latin America are limited.

Methods: We conducted an observational retrospective cohort study of treatment-naive (TN, n=315) and treatment-experienced (TE, n= 2356) people living with HIV prescribed BIC/FTC/TAF in Argentina from 10/2019 to 12/2021, with 24 and 48-week follow-up data analyzed for virological suppression, persistence, safety, and metabolic parameters. Patient-reported outcomes were assessed via across-sectional online survey.

Results: Baseline characteristics: median age 45 years, 72.2% male, 99.6% Hispanic/Latino ethnicity. Treatment per sistence at 48 weeks was 99.3% (TN) and 99.5% (TE). Virological suppression rates (<200/<50 copies/mL) at 24 weeks were 97.4/88% (TN) and 99/97% (TE). At 48 weeks were 100/92% (TN) and 99/97% (TE). In the TE group, triglycerides decreased with no other lipid changes. In TN, mild total/LDL/HDL cholesterol increases occurred. eGFR mildly decreased in both groups. The online survey (n=536) showed 91.5% reported no medication concerns. Median quality of life scores were 90 (TN) and 88 (TE). Most reported no self-care, activity, mobility, pain/discomfort, or anxiety/depression issues.

Conclusions: BIC/FTC/TAF demonstrated high persistence, safety, virological efficacy, and favorable metabolic profile over 48 weeks. The cross-sectional survey indicated high treatment satisfaction and good quality of life in this cohort from Argentina.