González Del Castillo J, Del Toro E, Fragiel M
… +2 more, Oteo D, García-Álvarez A
Rev Esp Quimioter
· 2025 Oct · PMID 41159224
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Sepsis remains a major cause of morbidity and mortality and continues to pose substantial diagnostic challenges in its early stages. Monocyte Distribution Width (MDW), a parameter automatically integrated into complete b...Sepsis remains a major cause of morbidity and mortality and continues to pose substantial diagnostic challenges in its early stages. Monocyte Distribution Width (MDW), a parameter automatically integrated into complete blood counts by next-generation haematology analysers, has emerged as a promising biomarker. This study evaluates the diagnostic performance of MDW compared with traditional markers (C-reactive protein and leukocyte count) and clinical scoring systems (SOFA and NEWS) in a cohort of critically ill patients presenting to a hospital emergency department, with the aim of distinguishing those with infection from those whose severity was attributable to other causes.
Rev Esp Quimioter
· 2025 Oct · PMID 41140261
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In 2023, a monoclonal antibody (niservimab) specifically targeting the "zero site (Φ)" of the prefusion form of the RSV F protein was marketed in Spain. Various studies have demonstrated its high efficacy in preventing h...In 2023, a monoclonal antibody (niservimab) specifically targeting the "zero site (Φ)" of the prefusion form of the RSV F protein was marketed in Spain. Various studies have demonstrated its high efficacy in preventing hospitalization and ICU admission in patients with RSV. However, the high cost of this monoclonal antibody, unaffordable in many developing countries, its inaccessibility, or religious beliefs may prevent its routine use in infants worldwide. Therefore, new treatment prospects have been explored through the development of low-cost, orally administered antiviral drugs that can be used anywhere, with or without the monoclonal antibody. In 2014, Ark Biosciences registered Roche's compound RO-0529 for clinical development and named it AK0529; in 2019, it was definitively designated ziresovir. This compound emerged from a program searching for RSV F protein inhibitors based on the benzoazepinequinoline compound. The data available to date suggest that ziresovir is a potent antiviral inhibitor of RSV F protein. When administered orally twice daily for 5 days, it produces a clear clinical improvement in bronchiolitis (signs and symptoms) and a decrease in viral load in the respiratory tract. This new antiviral is well tolerated with few adverse effects, but with the development of resistance during treatment in 11-18% of cases, especially at high doses.
Puerta-Alcalde P, Guinea J, Maseda E
… +1 more, Zaragoza R
Rev Esp Quimioter
· 2025 Oct · PMID 41140260
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Intra-abdominal candidiasis, which includes peritonitis and produced intra-abdominal abscesses, accounts for 10-30% of all intra-abdominal infections diagnosed in the intensive care units. Intra-abdominal candidiasis i...Intra-abdominal candidiasis, which includes peritonitis and produced intra-abdominal abscesses, accounts for 10-30% of all intra-abdominal infections diagnosed in the intensive care units. Intra-abdominal candidiasis is associated with longer hospital stay, and significantly higher morbidity and mortality. Although the management of invasive candidiasis has greatly improved in these past years, the optimal management of intra-abdominal candidiasis remains elusive. Questions concerning the microbiological diagnosis, optimal antifungal drugs doses, diffusion through peritoneal fluid, and the value of liposomal amphotericin B as first-line treatment, remain unanswered. In this article, three important issues concerning intraabdominal candidiasis have been re-viewed: microbiological diagnosis and risk of antifungal resistance emergence, pharmacokinetic/pharmacodynamic particularities of antifungals, and clinical management on the daily practice. Only an optimized multidisciplinary approach combining rapid diagnostics, tailored antifungal therapy, and effective source control will improve the management and prognosis of patients with intra-abdominal candidiasis.
Martín-Sánchez FJ, Laínez-Martínez S, López-Ayala P
… +6 more, Calvo-Manuel E, Del-Toro E, Chaparro-Pardo D, García-Briñón MÁ, González-Armengol JJ, González-Del-Castillo J
Rev Esp Quimioter
· 2025 Oct · PMID 41140259
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OBJECTIVES: To develop and validate a clinical model to predict 30-day mortality in high-risk COVID-19 patients evaluated in the Emergency Department, and to evaluate outcomes in adults with COVID-19 pneumonia classified...OBJECTIVES: To develop and validate a clinical model to predict 30-day mortality in high-risk COVID-19 patients evaluated in the Emergency Department, and to evaluate outcomes in adults with COVID-19 pneumonia classified as low-risk by the model and discharged home. METHODS: Secondary analysis of the COVID-19\_URG-HCSC registry at Hospital Clínico San Carlos (Madrid). Phase 1 (Feb-Apr 2020): derivation of a model in patients aged ≥18 years with probable or confirmed COVID-19 who were classified as high-risk at triage (age ≥55 years, baseline oxygen saturation <96% on arrival, or pulmonary infiltrates on chest radiograph). The primary outcome was 30-day all-cause mortality. Phase 2 (Sep 2020-May 2021): validation in adults with low-risk pneumonia discharged home and monitored by telephone. Primary outcomes were 30-day all-cause mortality, revisits, and hospitalization. RESULTS: Of 2,436 eligible patients in phase 1, age, oxygen saturation, renal function, LDH, CRP, platelet count and dementia were independent mortality predictors. The model showed excellent discrimination (AUC 0.918) and good calibration, and was implemented in a web-based tool. In phase 2, 565 patients with low-risk pneumonia were monitored; no deaths occurred at 30 days. Re-attendance was 8.0% and hospitalisation 12.6%, mainly for respiratory failure. All hospitalised patients were ultimately discharged home. CONCLUSIONS: The PrediCOVID model provides accurate risk stratification and, when combined with telemonitoring, enables safe early discharges while reducing hospital burden.
España-Marí G, Álvarez-Arroyo L, Alentado-Mateu A
… +2 more, Limón-Ramírez R, Montañés-Pauls B
Rev Esp Quimioter
· 2025 Sep · PMID 40948396
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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 po...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 × 10/L was observed; 15 days later, severe neutropenia (0.3 × 10/L) developed. Rifampicin and isoniazid were discontinued, while certolizumab was maintained; the neutrophil count recovered to 0.8 × 10/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.
González Corralejo C, Culebras López E, Martínez Rodríguez M
… +1 more, Delgado-Iribarren García-Campero A
Rev Esp Quimioter
· 2025 Sep · PMID 40948395
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Respiratory syncytial virus (RSV) infection is one of the main causes of morbidity and mortality in infants under 6 months of age; however, it can cause respiratory infection at other stages of life. In the period 2018-2...Respiratory syncytial virus (RSV) infection is one of the main causes of morbidity and mortality in infants under 6 months of age; however, it can cause respiratory infection at other stages of life. In the period 2018-2025, the number of cases has risen considerably, with positivity mainly concentrated in children under 24 months of age. The SARS-CoV2 pandemic caused modifications in affected population groups and seasonality. The percentage of RSV in children under 6 months of age in the period 2024-2025 was significantly lower than in the 2023-2024 season. In contrast, in the elderly population, especially those over 86 years of age, the percentage of positive cases has increased significantly. From 2022 onwards, the incidence of virus positivity shows a more stable and sustained pattern from October to April compared to previous years. The aim of this review is to assess the evolution of the type of patient diagnosed with RSV infection and to determine early whether the beginning of the vaccination campaign has reduced the incidence in the susceptible population. The availability of epidemiological information to guide decision-making is of great importance for evaluating the effectiveness of these measures and adopting changes in the use of vaccination in the general population.
Téllez-Castillo CJ, Müller L, Rekendt AK
… +2 more, Pra-Mio L, Scharmann C
Rev Esp Quimioter
· 2025 Sep · PMID 40948394
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INTRODUCTION: 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 rol...INTRODUCTION: 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 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 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: 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.
Martínez-de La Cruz P, Sánz-Márquez S, Valverde-Cánovas JF
… +6 more, Hervás-Gómez R, Martín-Segarra O, Vegas-Serrano A, Velasco-Arribas M, Losa-García JE, Moreno-Núñez L
Rev Esp Quimioter
· 2025 Sep · PMID 40698620
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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 Pr...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.
Zas-García MI, Fernández-Carreira JM, González-Fernández D
… +6 more, Castelo-Alvárez E, Rubio-Sanz J, Álvarez-Pérez M, Blanco-Suárez A, Rodríguez-Prida J, Rubio-Alfonso T
Rev Esp Quimioter
· 2025 Sep · PMID 40698619
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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...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.
Rev Esp Quimioter
· 2025 Jul · PMID 40607535
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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 mul...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.
Cecchini D, Bottaro E, Bacelar B
… +5 more, Tisné Á, Migazzi C, Roel M, Bergman M, Cassetti I
Rev Esp Quimioter
· 2025 Sep · PMID 40522630
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INTRODUCTION: Dolutegravir plus lamivudine (DTG/3TC) dual therapy has demonstrated efficacy in HIV treatment, but access remains challenging in Latin America. Argentina approved a generic co-packaged DTG+3TC presentation...INTRODUCTION: Dolutegravir plus lamivudine (DTG/3TC) dual therapy has demonstrated efficacy in HIV treatment, but access remains challenging in Latin America. Argentina approved a generic co-packaged DTG+3TC presentation to improve accessibility. This study evaluated the effectiveness and safety of co-packed DTG/3TC compared to DTG-based triple therapy in clinical practice. MATERIALS AND METHODS: A retrospective observational cohort study conducted between October 2019 and November 2023 at a reference HIV center in Argentina. Treatment-experienced people living with HIV (PLWH) with viral suppression who switched to either co-packaged DTG/3TC or DTG-based triple therapy were included. Primary outcomes included persistence, virologic suppression rates (VSR), and safety at 6, 12, and 18 months. RESULTS: Of 599 PLWH, 245 (41%) switched to dual therapy and 354 (59%) to triple therapy. Persistence rates for dual therapy at 6, 12, and 18 months were 99%, 100% and 98%; for triple therapy: 99%, 97% and 97%, respectively. VSR for dual therapy were 99%, 98% and 99%; for triple therapy: 99%, 97% and 98% at the same timepoints. Adverse event rates were low in both groups: dual therapy (0.5%, 0%, 0.8% at 6, 12, 18 months) and triple therapy (1.2%, 0.7%, 0.4% at 6, 12, 18 months). CONCLUSIONS: Co-packaged DTG/3TC demonstrated high persistence and virologic suppression rates with a favorable safety profile in clinical practice. Its effectiveness and safety were comparable to DTG-based triple therapy, supporting its use as a cost-effective alternative for treatment-experienced PLWH in resource-limited settings.
Lovatti-González R, Gómez-Pavón J, Bielza R
… +4 more, Hernando C, Martínez-Peromingo J, Mateos-Nozal J, Bermejo-Boixareu C
Rev Esp Quimioter
· 2025 Sep · PMID 40512605
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Acute respiratory infections (ARIs) are one of the main causes of morbidity, functional impairment, and mortality in institutionalised older adults. This group is highly vulnerable due to factors such as advanced age, mu...Acute respiratory infections (ARIs) are one of the main causes of morbidity, functional impairment, and mortality in institutionalised older adults. This group is highly vulnerable due to factors such as advanced age, multimorbidity, frailty, and structural barriers to infection prevention and control. This article reviews, in a question-and-answer format, the most recent evidence on the epidemiology, prevention and treatment of the most relevant respiratory infections in nursing homes: influenza, SARS-CoV-2, respiratory syncytial virus, and . Epidemiological changes after the COVID-19 pandemic, current vaccination strategies, the efficacy and characteristics of newly vaccines available, as well as the updated therapeutic approach according to resistance profiles and the availability of antivirals, are analysed. In addition, the clinical and functional impact that these infections can have on residents is addressed, as well as the need to find a balance between preventive measures and the quality of life of this population group. The importance of effective coordination between health and social care professionals, and the implementation of protocols adapted to the residential context is highlighted. The article provides practical, evidence-based recommendations to improve the prevention and treatment of these infections in a particularly vulnerable environment.
Artiles-León CM, Rodríguez-Restrepo S, Torres-Jiménez IA
… +8 more, de Las Delicias Quintana-Estellés M, Viedma-Moreno E, Arrazola-Martínez P, Jaén-Herreros F, Sanz-Gallardo I, Suárez-García E, Craviotto-Vallejo A, de Miguel-García S
Rev Esp Quimioter
· 2025 Jun · PMID 40464379
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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...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 (92.2%), followed by (4.2%), and (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.