Cecchini D, Brizuela M, Seleme MS
… +6 more, Mingrone MV, Copertari G, Bacelar B, Mauas R, Bottaro E, Cassetti I
Rev Esp Quimioter
· 2025 Feb · PMID 39564653
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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...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.
Maffezzoli P, Kestler M, Burillo A
… +4 more, Corcione S, De Rosa FG, Muñoz P, Bouza E
Rev Esp Quimioter
· 2025 Feb · PMID 39556409
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Time to positivity (TTP) refers to the duration required for a microbiological culture test to indicate a positive result, marking the onset of detectable bacterial or fungal growth in the sample. Numerous variables, inc...Time to positivity (TTP) refers to the duration required for a microbiological culture test to indicate a positive result, marking the onset of detectable bacterial or fungal growth in the sample. Numerous variables, including patient characteristics, infection source, former antimicrobial therapy, blood sample volume, and sample transportation time can influence the value of TTP. Several studies have been conducted on bloodstream infections, whereas studies on the clinical significance of yeast TTP are quite limited in the literature. Furthermore, many studies are retrospective and have a small sample size. In this opinion paper, we have formulated some questions and attempted to provide answers based on the available literature and our perspective. The objective of this opinion paper is to summarise current knowledge based on the literature, aiming to offer a critical perspective, particularly on aspects with weaker evidence, which could guide future studies in this area. We believe that TTP of blood cultures appears to exhibit considerable potential and may prove to be a valuable tool in clinical practice for estimating patient mortality risk and guiding antimicrobial therapy choices. Topics discussed include the diagnostic and prognostic role of TTP in Gram-positive and Gram-negative bacteremias and in candidemias, and the significance of differential time to positivity (DTTP). In summary, our opinion is that, based on the available literature, it is not possible to determine whether TTP provides prognostic information, particularly concerning candidemia. Therefore, clinical decisions cannot be systematically based on this parameter.
Piña Delgado C, Bolaños Rivero M, Carmona Tello MC
… +3 more, Ramírez Estupiñán CJ, Hernández Cabrera PM, de Miguel Martínez I
Rev Esp Quimioter
· 2025 Feb · PMID 39552499
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OBJECTIVE: Anaerobic bacteremia represents 0.5-12% of all bacteremias and its mortality is high, ranging from 25-44%. The aim was to know our data to compare them with existing data and demonstrate the importance of acti...OBJECTIVE: Anaerobic bacteremia represents 0.5-12% of all bacteremias and its mortality is high, ranging from 25-44%. The aim was to know our data to compare them with existing data and demonstrate the importance of actively searching for these microorganisms in blood culture samples. METHODS: A retrospective descriptive study in which the medical records of patients with significant episodes of anaerobic bacteremia were reviewed over a period of 8 years (2014-2022). RESULTS: A total of 59,898 blood cultures were processed, of which 10,451 were positive (17%). An anaerobic microorganism was identified in 209 patients. Anaerobic bacteremia accounted for 2.11% of the total number of positive blood cultures. The mean age was 63.55 years (17-96), 66% of whom were men. The origin was community in 63.64%, of nosocomial origin in 15.31% and associated with health care in 17.70%. The focus of infection was the abdominal (39.23%), followed by the respiratory (13.88%) and skin and soft tissues (13.39%). The most frequent comorbidities were: arterial hypertension (49.76%), dyslipidemia (29.67%), neoplasia (26.32%) and diabetes (26.32%). The main species isolated were the group Bacteroides spp. (44.50%) (n=93) highlighting Bacteroides group fragilis (n=65), followed by Clostridium spp. (20%) (n=42) highlighting Clostridium perfringens (n=30). The clinical evolution was good in 67.46%. The mean length of stay was 27.8 days and was associated with 20% mortality. CONCLUSIONS: Bacteremias due to anaerobes represented 2.11% of the total number of true bacteremias, so we consider the active search for these microorganisms to be appropriate.
Salmerón Béliz OJ, Pérez-Fernández E, Miró O
… +26 more, Aguiló S, Burillo-Putze G, Alquézar-Arbé A, Fernández-Alonso C, Jacob J, Montero Pérez FJ, Melcon Villalibre A, Cuerpo Cardeñosa S, Serrano Lázaro L, Caballero Martínez M, Muñoz Soler E, Bajo Fernández I, Castuera Gil AI, Hernando González R, Carbó-Jordá A, Cabrera Rodrigo I, Gros Bañeres B, Romero Carrete C, Ríos Gallardo R, Cortés Soler A, González Nespereira E, García García A, Oliva Ramos JR, Hinojosa Diaz L, González Del Castillo J, En nombre de los investigadores de la red Spanish Investigators in Emergency Situations TEam (SIESTA)
Rev Esp Quimioter
· 2025 Feb · PMID 39539217
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OBJECTIVE: To estimate the incidence of urinary tract infections (UTI) in elderly patients in Spanish emergency departments (ED), the need for hospitalization, diagnostic confirmation in hospitalized patients, adverse ev...OBJECTIVE: To estimate the incidence of urinary tract infections (UTI) in elderly patients in Spanish emergency departments (ED), the need for hospitalization, diagnostic confirmation in hospitalized patients, adverse events and the predictive capacity of several biomarkers. METHODS: In this a posteriori substudy of a generic study of reasons for ED visits in elderly patients, we included patients aged ≥65 years seen in 52 Spanish EDs for 1 week, selecting those diagnosed with UTI. As adverse events, in-hospital and 30-day mortality and combined adverse event (death or hospitalization) at 30 days post-discharge were collected. Relative risks (RR) were calculated. The predictive capacity of 10 variables and 6 biomarkers was investigated. RESULTS: A total of 25,375 patients were included, 1058 with UTI (annual incidence: 24.7 per 1000 inhabitants aged ≥65 years and year, 95%CI: 24.5-24.9). A total of 36.5% were hospitalized, and in 80% the diagnosis of UTI was confirmed at discharge. Overall 30-day mortality was 5.4% and in-hospital mortality was 3.4%. Functional dependence was associated with both events (RR:2.91;1.18-7.17 and RR:12.61;1.47-108.11, respectively), as was having a CRP greater than 100 mg/L (RR:2.24;1.17-4.30 and RR:3.21;1.37-7.51, respectively). The combined post-high event occurred in 10.6%, and was associated with functional dependence (RR:2.05;1.04-4.06). CRP and hemoglobin had significant value in predicting 30-day post-discharge mortality or hospitalization. CONCLUSIONS: UTI is a frequent diagnosis in elderly patients consulting in the ED. Functional dependence is the best factor associated with adverse events. The biomarkers analyzed do not have a good predictive capacity.
Aiello TF, Teijon-Lumbreras C, Gallardo-Pizarro A
… +9 more, Monzó-Gallo P, Martinez-Urrea A, Cuervo G, Del Rio A, Hernández-Meneses M, Morata L, Mensa J, Soriano A, Garcia-Vidal C
Rev Esp Quimioter
· 2025 Feb · PMID 39469850
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Clinical Decision Support Systems (CDSS) are computer-based tools that leverage the analysis of large volumes of health data to assist healthcare professionals in making clinical decisions, whether preventive, diagnostic...Clinical Decision Support Systems (CDSS) are computer-based tools that leverage the analysis of large volumes of health data to assist healthcare professionals in making clinical decisions, whether preventive, diagnostic, or therapeutic. This review examines the impact of CDSS on clinical practice, highlighting both their potential benefits and their limitations and challenges. We detail the experience of clinical medical professionals in the development of a virtual control center for COVID-19 patients (C3 COVID-19) in Spain during the SARS-CoV-2 pandemic. This tool enabled real-time monitoring of clinical data for hospitalized COVID-19 patients, optimizing personalized and informed medical decision-making. CDSS can offer significant advantages, such as improving the quality of inpatient care, promoting evidence-based clinical and therapeutic decision-making, facilitating treatment personalization, and enhancing healthcare system efficiency and productivity. However, the implementation of CDSS presents challenges, including the need for physicians to become familiar with the systems and software, and the necessity for ongoing updates and technical support of the systems.
Cabañas Morafraile J, de Rafael González E, Serrano Martín L
… +13 more, Rubio Díaz R, Torres Fernández M, Heredero Gálvez E, López Forero WE, Morell Jurado L, Canabal Berlanga R, Calafell Mas MF, Chaves Prieto E, Asensio Nieto MR, Thomas-Balaguer Cordero A, Lorenzo Lozano MC, Julián-Jiménez A, En nombre del grupo URGEN-LABQMIC del CHUT (IDISCAM).
Rev Esp Quimioter
· 2024 Dec · PMID 39405171
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OBJECTIVE: To analyze the diagnostic accuracy of the new MeMed® test to predict bacterial infection in adult patients seen in emergency departments (ED) with clinical suspicion of infection, as well as to compare its per...OBJECTIVE: To analyze the diagnostic accuracy of the new MeMed® test to predict bacterial infection in adult patients seen in emergency departments (ED) with clinical suspicion of infection, as well as to compare its performance with other commonly used biomarkers (protein C reactive-PCR-, procalcitonin -PCT-). 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 diagnosis of bacterial infection (BI) was considered as the dependent variable. The predictive ability was analyzed with the area under the curve (AUC) of the receiver operating characteristic (COR) and the values of sensitivity (Se), specificity (Es), positive predictive value (PPV) and negative predictive value (NPV) of the PCR, PCT, leukocyte count and the LIAISON® MeMed® test. RESULTS: The study included 258 patients, 54 (15.6%) of whom died within 30 days of visiting the ED. The mean age was 68.28 (SD 19.53) years, 57.4% (148) were men. At 30 days, the group with the IB diagnosis had 137 patients, the viral infection group 68 cases and 17 in the indeterminate group. The AUC-COR achieved by MeMed® in the group that analyzes all patients was 0.920 (95% CI: 0.877-0.962) and the PCT was 0.811 (95% CI: 0.754-0.867). With a cut-off point (PC) > 65 points of the MeMed® test, achieves a Se: 79.2% and Es: 91.2% and with PC > 90 points a Se: 57% and Es: 95.9%. Applying the Youden index, the PC > 50 points achieves Se:84.1% and Es:88.2%. CONCLUSIONS: In adult patients treated with clinical suspicion of infection in the ED, the LIAISON MeMed® test has a great ability to diagnose its bacterial origin and achieves better performance than PCT, PCR and leukocyte count.
Cecchini D, Sfalcin J, Zapiola I
… +9 more, Gomez A, Fernandez-Giuliano S, Rodriguez C, Mammana L, Seravalle A, Fay F, Torroija MC, Bugarín G, Bouzas MB
Rev Esp Quimioter
· 2024 Dec · PMID 39364596
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OBJECTIVE: To date, no data exist regarding the prevalence of integrase inhibitor (INSTI) resistance-associated mutations (HIVDRM) in HIV-infected pregnant women (HPW) in Latin America. We describe the prevalence and tra...OBJECTIVE: To date, no data exist regarding the prevalence of integrase inhibitor (INSTI) resistance-associated mutations (HIVDRM) in HIV-infected pregnant women (HPW) in Latin America. We describe the prevalence and transmissibility of integrase HIVDRM in a historical cohort of INSTI-naïve HPW from Argentina (n=56) with Next Generation Sequencing (NGS). METHODS: Bioinformatics analysis was performed by HyDRA software for 20%, 10%, 5%, 2%, and 1% sensitivity thresholds. We calculated the mutational viral load for each INSTI-HIVDRM, considering those with >1000 c/mL as of high risk of transmissibility. RESULTS: The predominant HIV subtype was BF (78.5%). Major HIVDRM were not detected with the population sequencing 20% filter. With a 1% threshold, the prevalence increased to 8.9%; Y143C/S, E92G, E138K, and T66I mutations were found. The median (range) mutational load (expressed in c/mL) was: 355 (50.2-11705); with only 1 case >1000 c/mL Accessory mutations (G163R/K, T97A) were detected mostly with a 20% sensitivity threshold with an overall prevalence of 23.2%; the median (IQR) mutational load was: 23929 (4009-63158) c/mL; all of them above 1000 c/mL. CONCLUSIONS: Our results show evidence of the presence of major INSTI-HIVDRM as aleatory mutations and a high frequency of accessory mutations with potential transmissibility in HPW.
Rev Esp Quimioter
· 2024 Dec · PMID 39348221
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OBJECTIVE: Prior research has not examined the size of antibiotic packages prescribed. We assessed 2023 prescription rates in Barcelona and the most prescribed presentations in pharmacies, while evaluating potential redu...OBJECTIVE: Prior research has not examined the size of antibiotic packages prescribed. We assessed 2023 prescription rates in Barcelona and the most prescribed presentations in pharmacies, while evaluating potential reductions if all amoxicillin and amoxicillin/clavulanate containers had 20 doses. METHODS: Antibiotics prescribed by primary care doctors working for the Catalonian Health Institute in Barcelona in 2023 were analysed by calculating the defined daily doses per 1,000 inhabitants and day (DID). RESULTS: The observed prescribing rate was 8 DID, with penicillins accounting for 4.6 DID (57.2%). The most frequently prescribed antibiotics were amoxicillin and amoxicillin/clavulanate, making up 4.4 DID. If all the 30-dose presentations of amoxicillin and amoxicillin/clavulanate had been 20-dose containers, the total number of DIDs would have been 3.3, resulting in a reduction of 1.1 DID (25.4% less). CONCLUSIONS: Antibiotic prescribing rate in Barcelona was low. Aligning the dosage of antibiotics with established guidelines could further reduce antibiotic consumption.
Rodríguez-Fernández R, González-Martínez F, Ojeda Velázquez I
… +5 more, Rodríguez Díaz M, Capozzi Bucciol MV, González-Sánchez MI, Pérez-Moreno J, Toledo Del Castillo B
Rev Esp Quimioter
· 2024 Dec · PMID 39308353
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OBJECTIVE: Respiratory syncytial virus (RSV) bronchiolitis is the leading cause of hospitalization in infants. This season, a long half-life monoclonal antibody (Nirsevimab) is available to prevent this disease for all i...OBJECTIVE: Respiratory syncytial virus (RSV) bronchiolitis is the leading cause of hospitalization in infants. This season, a long half-life monoclonal antibody (Nirsevimab) is available to prevent this disease for all infants born from 1 April-30 September to 2023 and all those born during RSV season (October2023- March 2024). The aim of this study was to evaluate the impact of the implementation of this antibody on RSV admissions in a tertiary hospital. METHODS: Observational, retrospective and analytical study. All patients <6 months in October admitted for bronchiolitis at 2 time points were included: T1 or Pre-nirsevimab time: 1 September 2015-30 September 2023 and T2 or Nirsevimab time: 1 October-31 December 2023. Total admissions due to any cause of infants <6 months in the same period were used as the reference population. To assess the impact of the implementation of nirsevimab, we calculated the reduction in the percentage of admissions due to RSV with respect to total admissions in both periods, and also in the 2023-2024 season we calculated the double negative test to calculate the effectiveness of the intervention (1-Odds ratio) x 100. RESULTS: In infants under 6 months of age, we found significant differences in the number of admissions for RSV bronchiolitis between the last season and the previous 7 seasons [574/1195 (48%) vs 6/138 (4.3%); p<0.01, RPI: 91%). In the 2023/2024 season, the effectiveness of nirsevimab in preventing admission for RSV bronchiolitis in children under 6 months of age was 85% (CI 95%: 32-97%). CONCLUSIONS: The implementation of nirsevimab has had an important impact on the number of hospital admissions for RSV bronchiolitis. There were no differences in the severity of bronchiolitis.
Cobo F, Reguera-Márquez JA, Marín-Rodríguez JA
… +4 more, Martín-Pérez FJ, Pérez-Palacios P, Recacha E, Navarro-Marí JM
Rev Esp Quimioter
· 2024 Dec · PMID 39297392
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OBJECTIVE: The aim of this study was to evaluate the microbiological epidemiology of carbapenemase-producing Gram-negative bacilli (CPGNB) isolated from blood during a 5-year period. METHODS: A total of 80 isolates from...OBJECTIVE: The aim of this study was to evaluate the microbiological epidemiology of carbapenemase-producing Gram-negative bacilli (CPGNB) isolated from blood during a 5-year period. METHODS: A total of 80 isolates from 78 patients were finally included; fifty-five (70.5%) were men and the mean age was 60 years. Detection of carbapenemase production was performed by immunocromatography (IC) and polymerase chain reaction (PCR). Genotyping was carried-out by pulsedfield gel electrophoresis (PFGE) and multi-locus sequence typing (MLST), and characterization of carbapenemase-producing isolates was performed by whole genome sequencing (WGS). RESULTS: The main microorganisms isolated were K. pneumoniae (29.4%), E. cloacae (28.2%), A. baumannii (17.9%) and P. aeruginosa (15.3%). Overall, the most common carbapenemase in Enterobacterales was OXA-48 group (57.7%). The most common carbapenemase in non-fermenting bacilli was OXA-23 (60.8%). The most common ST in K. pneumoniae producing OXA-48 types was ST45 and in E. cloacae ST114, while in E. cloacae producing VIM types was ST78. In OXA-23 types, the most common clone in A. baumannii was ST2, whereas in P. aeruginosa producing IMP types was ST253. CONCLUSIONS: There was an increase in cases recorded in the years of highest incidence and severity of the SARS-CoV-2 pandemic, with a significant number of cases in patients admitted to the ICU. All bacteremias caused by A. baumannii were caused by the same clone, and 12 of the 14 cases caused by A. baumannii were part of outbreaks in the ICU.
Martín-Delgado MC, De Lucas Ramos P, García-Botella A
… +20 more, Cantón R, García-Lledó A, Hernández-Sampelayo T, Gómez-Pavón J, González Del Castillo J, Martín Sánchez FJ, Martínez-Sellés M, Molero García JM, Moreno Guillén S, Rodríguez-Artalejo FJ, Ruiz-Galiana J, Burillo A, Muñoz P, Calvo Rey C, Catalán-González M, Cendejas-Bueno E, Halperin-Benito V, Recio R, Viñuela-Benítez C, Bouza E
Rev Esp Quimioter
· 2024 Dec · PMID 39076142
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Group A ß-hemolytic Streptococcus (S. pyogenes), also known as GAS, is a Gram-positive bacterium. It can be easily identified in the microbiology laboratory by its ability to hemolyse blood in culture media. This bacteri...Group A ß-hemolytic Streptococcus (S. pyogenes), also known as GAS, is a Gram-positive bacterium. It can be easily identified in the microbiology laboratory by its ability to hemolyse blood in culture media. This bacterium is highly virulent due to its production of enzymes and toxins, and its ability to cause immunologically mediated diseases such as rheumatic fever and post-streptococcal glomerulonephritis. GAS is the primary cause of bacterial pharyngotonsillitis, although it is typically a benign and non-invasive disease. However, it also has the potential to cause severe skin and soft tissue infections, necrotising fasciitis, bacteraemia and endocarditis, pneumonia and empyema, and streptococcal toxic shock syndrome, without any age or predisposition limits. The term invasive GAS disease (iGAS) is used to refer to this group of conditions. In more developed countries, iGAS disease has declined thanks to improved hygiene and the availability of antibiotics. For example, rheumatic fever has practically disappeared in countries such as Spain. However, recent data suggests a potential increase in some iGAS diseases, although the accuracy of this data is not consistent. Because of this, the COVID and Emerging Pathogens Committee of the Illustrious Official College of Physicians of Madrid (ICOMEM) has posed several questions about invasive GAS infection, especially its current situation in Spain. The committee has enlisted the help of several experts in the field to answer these questions. The following lines contain the answers that we have collaboratively produced, aiming to assist not only the members of ICOMEM but also anyone interested in this topic.