Garnacho-Montero J, Aguado JM, Alemparte E
… +6 more, Horcajada JP, López-Medrano F, Ramírez P, Giró-Perafita A, Blasco M, Suberviola B
Rev Esp Quimioter
· 2025 May · PMID 39998237
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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 becaus...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.
Favier P, Raffo C, Torres D
… +7 more, Gismondi M, Piñeiro F, Blugerman G, Erbin M, Pérez J, Sued O, Rolón MJ
Rev Esp Quimioter
· 2025 May · PMID 39995309
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INTRODUCTION: Community-acquired methicillin-resistant (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 felin...INTRODUCTION: Community-acquired methicillin-resistant (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.
Barberán J, Ramos M, Villanueva J
… +16 more, Villares P, Villareal M, Vivas M, Orche S, Tejera-Gonzalez M, Menéndez JM, Hinojosa LT, Almirall C, Antolin L, Martinez L, Mendoza S, Pelaez A, Segarra-Cañamares M, Guerrero JE, Pelaez J, Cardinal-Fernández P
Rev Esp Quimioter
· 2025 Mar · PMID 39950446
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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, a...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.
Sánchez-Herrero H, Solaz-García Á, Pinilla-González A
… +3 more, Martínez-Sánchez EV, Santágueda-Balader P, Cernada-Badía M
Rev Esp Quimioter
· 2025 Mar · PMID 39927581
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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...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.
Peregrina-Rivas JA, Fernández-Reyes D, de Salazar-González A
… +4 more, García-García F, Montero-Alonso MÁ, Hernández-Quero J, Guirao-Arrabal E
Rev Esp Quimioter
· 2025 Mar · PMID 39927580
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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....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.
Rodríguez-Ayala M, Cacho-Calvo J, Cendejas-Bueno E
Rev Esp Quimioter
· 2025 Mar · PMID 39927579
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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 ai...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 (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 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 bacteremia enabled physicians and AMS teams to optimize AT.
Castellano-Sánchez L, Rosales-Castillo A, Olvera-Porcel MC
… +2 more, Navarro-Marí JM, Gutiérrez-Fernández J
Rev Esp Quimioter
· 2025 Mar · PMID 39927578
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INTRODUCTION: The prevalence, clinical characteristics, and antibiotic susceptibility of the slow-growing microorganisms , and spp. in urine cultures are analyzed. MATERIAL AND METHODS: Descriptive and retrospective cro...INTRODUCTION: The prevalence, clinical characteristics, and antibiotic susceptibility of the slow-growing microorganisms , and spp. in urine cultures are analyzed. MATERIAL AND METHODS: Descriptive and retrospective cross-sectional study carried out in a Regional Hospital. Reports of clinical episodes with single isolation of the aforementioned microorganisms were selected between January 2016 and December 2023. RESULTS: A total of 186 single-isolation episodes were included, corresponding to 0.44% of the total. The most frequently isolated species was . Overall, the risk factors were the presence of an indwelling bladder catheter (24.73%), immunosuppression (24.19%), health care (35.48%), diabetes mellitus (19.89%), nephrourological disorders (31.18%) and previous antibiotherapy (35.48%). Urinary tract infections due to spp. predominated in elderly patients, with nephrourological disorders and a history of antibiotic therapy in the previous 3 months. and were associated with immunosuppression, healthcare contact and previous antibiotherapy. was also associated with the presence of an indwelling bladder catheter. CONCLUSIONS: Slow-growing opportunistic emerging microorganisms represent a small percentage of the aetiological agents in urinary tract infections, although of important and growing clinical interest given their pathogenic role in the presence of certain circumstances and risk factors, as well as the challenges they pose for laboratory diagnosis. It is essential to perform antibiograms for an adequate targeted treatment.
Hidalgo E, González-Torralba A, Ramón J
… +1 more, Alós JI
Rev Esp Quimioter
· 2025 Feb · PMID 39704031
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OBJECTIVE: Escherichia coli is isolated in most of uncomplicated community-acquired urinary tract infections (UTI) and fosfomycin is one of the treatments of choice. We analyzed the evolution of fosfomycin resistance in...OBJECTIVE: Escherichia coli is isolated in most of uncomplicated community-acquired urinary tract infections (UTI) and fosfomycin is one of the treatments of choice. We analyzed the evolution of fosfomycin resistance in extrahospitalary E. coli urinary isolates and whether age and extended spectrum beta-lactamase (ESBL) production were associated to antibiotic resistance. METHODS: A retrospective descriptive study was conducted from January 2017 to December 2022 including E. coli isolates from extrahospitalary urine samples. RESULTS: The susceptibility to fosfomycin remained above 95% during the study period. ESBL production and age above 80 years were significantly associated with increased fosfomycin resistance. We also analyzed the consumption of fosfomycin and it remained stable, although it was higher in the population >65 years. CONCLUSIONS: Greater resistance is observed in ESBL-producing strains and in patients over 65 years of age. A stable consumption of fosfomycin is associated with low resistance percentages maintained over the time.
Barbero Allende JM, Ureña I, Cañivano L
… +20 more, García S, Paz C, Olmo-Ruiloba A, Jauregi K, Coronado S, López Requejo L, Porcel L, Perea V, Irigoyen M, Cano J, García A, León E, Fernández-Domingo N, Lanchares P, Lino B, Ortolá M, Lizasoain A, Sánchez V, Arévalo-Cañas C, Arévalo-Serrano J
Rev Esp Quimioter
· 2025 Feb · PMID 39588562
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OBJECTIVE: One of the main problems with Clostridioides difficile infection (CDI) is its tendency to recur. The objective of the study is to analyze which factors in the clinical management of CDI favor recurrence. METHO...OBJECTIVE: One of the main problems with Clostridioides difficile infection (CDI) is its tendency to recur. The objective of the study is to analyze which factors in the clinical management of CDI favor recurrence. METHODS: This is a retrospective study conducted at the Hospital Universitario Príncipe de Asturias on cases of CDI between January 2021 and June 2023. Demographic variables, comorbidities, risk factors for recurrence, and treatments used for CDI were recorded. Non-optimal clinical management was defined as: not discontinuing treatment with proton pump inhibitors (PPIs) if the patient was on them, not discontinuing concomitant antibiotic treatments if the patient was on these, the use of metronidazole monotherapy in any case, or the use of standard-dose vancomycin if there were risk factors for recurrence. RESULTS: A total of 327 cases were found in 256 patients. 69 patients died within 8 weeks after the episode (26.9%). Among the remaining 258 episodes, there were 68 recurrences (26.3%). Of these 68 recurrences, 63 cases received nonoptimal treatment (93.2%), compared to 112/190 (58.9%) among those who did not recur. In the multivariate analysis adjusted for confounding factors, patients who received optimal treatment had an 89% lower risk of recurrence compared to those who did not receive it (OR 0.1; p < 0.001). CONCLUSIONS: Reducing the use of PPIs and antibiotics and prioritizing more effective treatments against CDI could improve the recurrence rates of this infection.