Puyana-Rodríguez JM, Guida-Piqueras M, Navas-Elorza E
… +6 more, Molina-Borao I, Rivero-Jiménez N, Garrido-Lestache Rodríguez-Monte ME, Fortún-Abete J, Del-Cerro-Marín MJ, Álvarez-Fuente M
Rev Esp Quimioter
· 2025 Dec · PMID 41342595
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Castellares-González CI, Sanz-Moreno JC, Garrido-Buenache AI
… +2 more, Arrazola-Martínez P, de-Miguel-García S
Rev Esp Quimioter
· 2025 Dec · PMID 41342594
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INTRODUCTION: Pneumococcal meningitis is a severe form of invasive pneumococcal disease (IPD). Despite the changes introduced by conjugate vaccines, pneumococcal meningitis remains a major clinical and public health chal...INTRODUCTION: Pneumococcal meningitis is a severe form of invasive pneumococcal disease (IPD). Despite the changes introduced by conjugate vaccines, pneumococcal meningitis remains a major clinical and public health challenge. Analyzing its current patterns allows the identification of serotypes that retain a higher invasive potential, the assessment of their relationship with clinical outcomes, and the guidance of future preventive strategies. METHODS: Retrospective descriptive study of patients with pneumococcal meningitis admitted between 2018 and 2024. Clinical, demographic, and microbiological variables were analyzed, including identified serotypes, markers of severity (ICU, intubation, death), vaccination status, and antimicrobial sensitivity. RESULTS: Thirty-six cases of pneumococcal meningitis were identified (8 pediatric, 28 adults), with a case fatality rate of 19.4% and an ICU admission rate of 69.4%. The serotype was identified in 88.9% of cases, with 17 different serotypes detected. The most aggressive serotypes were 8, 3, 16, 33, and 23B, and the most lethal were 8, 3, 23A, 25A, and 9N. Seventy-five percent of adults had an indication for vaccination, but only half had received any doses. Resistance to cefotaxime was documented in three strains (9N, 19A, 23F), one of which was associated with a fatal outcome. CONCLUSION: Pneumococcal meningitis remains a serious condition. Serotypes such as 8 and 3 are associated with high mortality rates. Low vaccination coverage in at-risk groups represents a critical gap in prevention. Knowing the serotypes involved and their resistance profiles is key to adapting vaccination strategies and reducing the burden of this disease.
Dotis J, Antachopoulos C, Papadopoulou A
… +1 more, Printza N
Rev Esp Quimioter
· 2025 Nov · PMID 41307912
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INTRODUCTION: -associated primary peritonitis is an exceptionally rare condition that may present as spontaneous bacterial peritonitis (SBP) or peritoneal dialysis-related peritonitis (PDrP). We investigated demographic...INTRODUCTION: -associated primary peritonitis is an exceptionally rare condition that may present as spontaneous bacterial peritonitis (SBP) or peritoneal dialysis-related peritonitis (PDrP). We investigated demographic and clinical characteristics of these two entities caused by species. METHODS: A systematic review of the literature was undertaken to identify published cases of primary peritonitis caused by species and perform comparative analysis. Cases were categorized as SBP or PDrP and analyzed for demographics, clinical features, microbiology, treatment regimens and outcomes. RESULTS: A total of 33 cases were identified: 22 of SBP and 11 of PDrP. Among these, SBP cases occurred predominantly in older cirrhotic males (mean age 55.2 years), with isolated mainly from blood cultures (72.7%) and an associated mortality rate of 13.6%. In contrast, PDrP cases involved younger, generally healthier individuals on PD (mean age 47.5 years), where was universally isolated from peritoneal fluid and mortality was 0%. Catheter removal was required in 36.4% of PDrP cases. Epidemiological risk factors were more common in PDrP (81.8% vs. 45.5%). Blood culture positivity was significantly higher in SBP (p=0.016), while peritoneal fluid cultures were more often diagnostic in PDrP (p=0.028). Most patients received combination therapy with doxycycline and rifampicin, while treatment duration tended to be longer in PDrP. CONCLUSION: peritonitis shows differing patterns in SBP and PDrP. Early identification and appropriate intervention are essential for favorable clinical results.
Reyes-Gualito A, Rivera-Garay LR, Cobo-Alva A
… +3 more, Orozco-Uriarte MJ, Macías AE, Álvarez-Canales JA
Rev Esp Quimioter
· 2025 Nov · PMID 41307911
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INTRODUCTION: Current antimicrobial susceptibility methods fail to capture the variability of AmpC induction pathways in . This leads to preventable errors in ceftazidime susceptibility reporting. We introduce a reinterp...INTRODUCTION: Current antimicrobial susceptibility methods fail to capture the variability of AmpC induction pathways in . This leads to preventable errors in ceftazidime susceptibility reporting. We introduce a reinterpretation for the disk approximation test, based on the categorical change in ceftazidime susceptibility upon imipenem exposure. MATERIALS AND METHODS: A total of 73 ceftazidime-susceptible isolates were evaluated. Automated broth microdilution test was the reference standard. AmpC inducibility was conventionally defined as a ≥5 mm flattening of the ceftazidime inhibition zone adjacent to imipenem. Our novel criterion for inducibility was a change in ceftazidime category from susceptible to nonsusceptible. The probability of error in ceftazidime reporting was evaluated with three parameters. ROC curve, comparative and regression analyses were performed. RESULTS: The reference method showed an overall error probability of 35.6%. The conventional 5 mm cutoff interpretation reduced this rate to 5.4%, but generated a significant proportion of false positives and negatives. Regression analyses showed that the flattening effect is a strong predictor of the categorical change. No association was found between basal ceftazidime susceptibility and AmpC inducibility. CONCLUSION: Our reinterpretation criterion for disk approximation test turns a phenotypic assay into a clinically relevant diagnostic tool to avoid errors in ceftazidime susceptibility reports. Moreover, this interpretation is readily applicable in routine microbiology laboratories, and has the potential to be directly useful for antimicrobial stewardship efforts.
Gil-de-Miguel Á, Navarro-Alonso JA, Arrazola-Martínez MP
… +12 more, Cantarero D, Arellano M, Cremades-Bernabéu A, Fernández-Prada M, Gil-Prieto R, Gracia D, Martínez-Palancar E, Pérez-Martín JJ, Redondo-Margüello E, Sebastián N, Tolosa-Martínez N, Bouza E
Rev Esp Quimioter
· 2025 Nov · PMID 41235775
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Despite progress in adult vaccination schedules, coverage rates remain suboptimal in Spain. This opinion paper, authored by a multidisciplinary group of experts, analyzes the causes and consequences of adult undervaccina...Despite progress in adult vaccination schedules, coverage rates remain suboptimal in Spain. This opinion paper, authored by a multidisciplinary group of experts, analyzes the causes and consequences of adult undervaccination, covering clinical, social, economic, and ethical aspects. Over 10 million individuals aged 65+ are targeted for vaccination, along with adults with chronic illnesses. However, coverage remains low, with significant disparities across vaccines, regions, and risk groups. The causes of the "vaccination gap" include lack of training among healthcare professionals, organizational barriers, misinformation, low-risk perception among the public, and weak institutional engagement. This situation leads to increased morbidity, mortality, and avoidable costs for the healthcare system. Universal adult vaccination could significantly reduce these burdens. The document outlines structured solutions: targeted professional training, multicomponent strategies, centralized vaccination registries, effective public awareness campaigns, improved access, and integration of vaccination across all healthcare levels. The key role of healthcare workers, patient organizations, and the media is emphasized in improving vaccination coverage.
Rev Esp Quimioter
· 2025 Oct · PMID 41159236
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This manuscript summarizes the most relevant publications and international conference presentations on HIV infection between 2022 and 2024. It provides updated epidemiological data on HIV in Spain and assesses healthcar...This manuscript summarizes the most relevant publications and international conference presentations on HIV infection between 2022 and 2024. It provides updated epidemiological data on HIV in Spain and assesses healthcare professionals' knowledge regarding HIV transmission and prevention. It also discusses the REPRIEVE study, given its significant clinical implications for the management of people living with HIV. In addition, it reviews recent advances in antiretroviral therapy and pre-exposure prophylaxis, focusing on dual therapy regimens and long-acting injectable treatments, due to their significant clinical impact on the management of people living with HIV.
Rev Esp Quimioter
· 2025 Oct · PMID 41159235
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Cytomegalovirus (CMV) infection is a leading cause of morbidity and mortality among immunocompromised individuals, especially hematopoietic stem cell transplant and solid organ transplant recipients. In recent years, sig...Cytomegalovirus (CMV) infection is a leading cause of morbidity and mortality among immunocompromised individuals, especially hematopoietic stem cell transplant and solid organ transplant recipients. In recent years, significant advances have transformed the approach to CMV prevention and therapy. This manuscript explores key evidence regarding antiviral prophylaxis, treatment strategies, resistance mechanisms, and the potential of immune-guided monitoring in transplant settings. The role of novel agents such as letermovir and maribavir is highlighted. These findings support personalized strategies that balance efficacy, toxicity, and resistance in managing CMV infection.
Blanes Hernández R, de Cossio Tejido S, Puchades Gimeno F
… +2 more, García-Bustos V, Salavert Lletí M
Rev Esp Quimioter
· 2025 Oct · PMID 41159234
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Suboptimal antimicrobial use is a global challenge driven by entrenched misconceptions and dogmas. This article aims to critically evaluate and debunk several widespread myths in infectious disease management that lead t...Suboptimal antimicrobial use is a global challenge driven by entrenched misconceptions and dogmas. This article aims to critically evaluate and debunk several widespread myths in infectious disease management that lead to overdiagnosis and overtreatment. Through a nonsystematic literature review, this manuscript examines key misconceptions across various aspects of antimicrobial therapy, including administration routes, drug mechanisms, treatment duration, and the interplay with infection source control. It also explores the influence of evolving concepts like long-acting antimicrobials and the human microbiome. We challenge the dogmas that intravenous antibiotics are superior to oral agents, that longer courses are always better, and that bactericidal drugs are more effective than bacteriostatic ones. The review highlights the paramount importance of source control and surgical intervention in treating severe infections and cautions against misinformation surrounding the human microbiome. The medical community must critically re-evaluate long-standing clinical practices to improve antibiotic stewardship. By debunking these myths, we can promote a more precise, safe, and effective approach to antimicrobial use, ultimately reducing unnecessary prescribing and combating antimicrobial resistance.
Soriano-Cuesta MC, López-Olivencia M, Candel FJ
… +1 more, García-Plaza S
Rev Esp Quimioter
· 2025 Oct · PMID 41159233
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The treatment of infections caused by multidrug-resistant microorganisms (MDROs) in critically ill patients remains a major clinical challenge due to the high mortality associated with therapeutic failure. Delays in admi...The treatment of infections caused by multidrug-resistant microorganisms (MDROs) in critically ill patients remains a major clinical challenge due to the high mortality associated with therapeutic failure. Delays in administering effective antibiotics is a determining factor, especially in patients with sepsis. The presence of MDROs is one of the main causes of failure of empirical treatment. Identifying patients at risk of MDRO infection is essential, although complex. Factors such as prior use of antibiotics disrupt the intestinal microbiome balance and promote colonization by MDROs. Immunosuppression, disruption of physical barrier, systemic or organ-specific frailty, and the length of hospital stay increase the risk of colonization and infection by MDROs. In patients with sepsis and a high risk of MDRO infection, empirical therapy should be broad-spectrum and administered early. Traditionally, combination therapy has been recommended, preferably including a classical β-lactam together with aminoglycosides or colistin-drugs that may be suboptimal in certain infection sites and are associated with significant toxicity risks. The new broad-spectrum β-lactams, already validated as first-line targeted treatment, are emerging as a promising empirical option in selected patients. Their early use, guided by colonization status, can optimize initial coverage in terms of spectrum and pharmacokinetic/pharmacodynamic, and reduces delays in the initiation of effective treatment. This strategy should be integrated into antimicrobial stewardship programs and be followed by deescalation once microbiological results are available.
Rev Esp Quimioter
· 2025 Oct · PMID 41159232
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This document focuses on the different aspects to be considered in order to improve the management of nosocomial peritonitis, particularly the changes in the epidemiology of causative microorganisms and the increasing em...This document focuses on the different aspects to be considered in order to improve the management of nosocomial peritonitis, particularly the changes in the epidemiology of causative microorganisms and the increasing emergence of pathogens resistant to commonly used antimicrobials. To facilitate their identification and treatment, the latest advances in microbiological diagnosis and evidence on the efficacy of new antimicrobial alternatives against resistant microorganisms are presented. All these factors, together with measures aimed at reducing treatment duration, also addressed in this document, will be analyzed in depth in a second paper to be published shortly.
Pina-Sánchez M, Rua M, Candel FJ
… +1 more, Del Pozo JL
Rev Esp Quimioter
· 2025 Oct · PMID 41159231
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The spread of metallo-β-lactamases (MBL)-producing Gram-negative bacilli represents a global health challenge, associated with increased mortality rates. The prevalence of MBL-producing isolates, particularly of New Delh...The spread of metallo-β-lactamases (MBL)-producing Gram-negative bacilli represents a global health challenge, associated with increased mortality rates. The prevalence of MBL-producing isolates, particularly of New Delhi metallo-β-lactamase (NDM) subclass, is increasing globally. The optimal antibiotic for infections depends on the species and MBL subclass produced. Currently, the antimicrobial cornerstones against these pathogens are aztreonam/avibactam and cefiderocol. Successful therapy requires the early and adequate initiation of antibiotic treatment, optimisation of its pharmacokinetics/pharmacodynamics, and appropriate control of the infection source.
Rev Esp Quimioter
· 2025 Oct · PMID 41159230
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Nosocomial pneumonia is one of the most common nosocomial infections and is associated with significant clinical and economic burdens, such as long-term hospitalization, high medical costs, and increased morbidity and mo...Nosocomial pneumonia is one of the most common nosocomial infections and is associated with significant clinical and economic burdens, such as long-term hospitalization, high medical costs, and increased morbidity and mortality. The increasing incidence of nosocomial pneumonia caused by multidrug-resistant bacteria is a challenge in certain clinical settings, as it often carries a higher risk of delays in initiating an appropriate treatment and, therefore, a worse prognosis. The aim of this article is to analyze some of the key aspects that should be taken into account when choosing an antibiotic treatment for a patient with a nosocomial pneumonia in a multidrug-resistant environment.
Muñoz-Echeverria L, Sánchez-Cano JG, Losa-García JE
Rev Esp Quimioter
· 2025 Oct · PMID 41159229
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Primary immunodeficiencies, now referred to as inborn errors of immunity (IEI), are increasingly recognized in adults, not only in the pediatric population. In adults, they may present with recurrent, severe, or unusual...Primary immunodeficiencies, now referred to as inborn errors of immunity (IEI), are increasingly recognized in adults, not only in the pediatric population. In adults, they may present with recurrent, severe, or unusual infections, but also with autoimmunity, malignancy, allergies, or inflammation, posing a diagnostic challenge. This review is based on clinical experience and the 2022 International Union of Immunological Societies classification. It includes four clinical cases and proposes a practical approach for the evaluation of adults. In the presence of suspected IEI, a stepwise laboratory approach is proposed to facilitate early detection and improve prognosis. Initial screening with basic immunological tests-including complete blood count, immunoglobulin and complement levels, and lymphocyte immunophenotyping-is emphasized. Confirmation of each IEI requires more specific testing, often involving molecular techniques.
Maldonado-Barrueco A, Quiles-Melero I, García-Rodríguez J
Rev Esp Quimioter
· 2025 Oct · PMID 41159228
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Invasive fungal infections are a major cause of morbidity and mortality in critically ill patients, with an increasing global incidence and species diversity, especially after the SARS-CoV-2 pandemic. Diagnosis relies on...Invasive fungal infections are a major cause of morbidity and mortality in critically ill patients, with an increasing global incidence and species diversity, especially after the SARS-CoV-2 pandemic. Diagnosis relies on a combination of classical methods (microscopy, culture) and non-classical tools including biomarkers (1,3-β-D-glucan, galactomannan, mannan) and molecular assays. Fungal infections (candidiasis, aspergillosis, pneumocystosis, and mucormycosis) requires tailored diagnostic strategies based on host risk factors, epidemiology and specimen type. Combining diagnostic tests improves sensitivity and negative predictive value, guiding timely antifungal treatment. An integrated, pathogen-specific approach is essential to improve outcomes in the critical ill patient.
Rev Esp Quimioter
· 2025 Oct · PMID 41159227
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The timely and appropriate administration of empirical antibiotic therapy is critical for patient survival. However, several studies suggest that approximately 20-30% of patients presenting with sepsis receive inadequate...The timely and appropriate administration of empirical antibiotic therapy is critical for patient survival. However, several studies suggest that approximately 20-30% of patients presenting with sepsis receive inadequate antibiotic treatment, a factor strongly associated with increased mortality. Furthermore, approximately 20% of these patients experience adverse effects. The emergence of multidrug-resistant bacteria has significantly complicated the selection of appropriate antibiotic therapy and contributed to increased mortality. This challenge is particularly pronounced in conditions such as ventilator-associated pneumonia and bacteremia of various origins, which represent some of the most common infectious pathologies in the intensive care unit. This has resulted in the development of a range of rapid diagnostic tools, including syndromic panels. The primary objective of these panels is to identify the causative agent of infection at an early stage and to guide the selection of the optimal treatment as quickly as possible.
Rev Esp Quimioter
· 2025 Oct · PMID 41159226
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This non-exhaustive minireview describes the main characteristics of the new beta-lactamase inhibitors (enmetazobactam, avibactam, relebactam, durlobactam, zidebactam, nacubactam, vaborbactam, taniborbactam, and xeruborb...This non-exhaustive minireview describes the main characteristics of the new beta-lactamase inhibitors (enmetazobactam, avibactam, relebactam, durlobactam, zidebactam, nacubactam, vaborbactam, taniborbactam, and xeruborbactam), their spectrum of inhibition, their activity in combination with different beta-lactams, the main resistance mechanisms that can compromise their activity and the main applications of the different beta-lactam-beta-lactamase inhibitor combinations depending on the type of beta-lactamase/carbapenemase and the microorganism involved.
Rev Esp Quimioter
· 2025 Oct · PMID 41159225
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Sepsis is a life-threatening condition resulting from the body's dysregulated response to infection that demands timely diagnosis and effective antimicrobial treatment to reduce mortality and healthcare burden. Microbiol...Sepsis is a life-threatening condition resulting from the body's dysregulated response to infection that demands timely diagnosis and effective antimicrobial treatment to reduce mortality and healthcare burden. Microbiology laboratories play a critical role in sepsis management by delivering rapid and accurate diagnostic information. This article explores the framework and implementation of diagnostic stewardship programs, their integration with antimicrobial stewardship programs, and the evolving microbiological techniques enabling earlier, targeted antimicrobial therapy in sepsis. We highlight the critical synergy between microbiology, clinical teams and innovation, in optimizing patient outcomes.