BACKGROUND: Empirical linezolid for respiratory infections risks overtreatment and therapeutic inertia. Methicillin-resistant (MRSA) nasal swabs have high negative predictive value for ruling out MRSA pneumonia, yet the...BACKGROUND: Empirical linezolid for respiratory infections risks overtreatment and therapeutic inertia. Methicillin-resistant (MRSA) nasal swabs have high negative predictive value for ruling out MRSA pneumonia, yet their systematic integration into clinical practice remains poorly documented in Spain. The aim of the study was to quantify three sequential quality gaps in the empirical linezolid prescribing process and estimate the potential for improvement through an antimicrobial stewardship programme (ASP). METHODS: A retrospective observational study of 83 patients receiving empirical linezolid for respiratory infections at a secondary-level hospital during five non-consecutive months of 2025. Three quality gaps were defined: Gap 0 (initiation without MRSA risk criteria); Gap 1 (failure to request a nasal swab in eligible patients); and Gap 2 (therapeutic inertia following a negative result). RESULTS: Gap 0 affected 30.1% of patients, predominantly CAP (72%), discontinuation was more frequent in Gap 0 patients than in eligible candidates. Gap 1 affected 32.5%, with marked inter-unit variability: swabs were requested in 78% of Internal Medicine patients versus 41.7% in Respiratory Medicine. Among 56 patients with results, 85.7% were negative; Gap 2 affected 20.8%, generating 56 days of linezolid administered after a negative result was available. Patients with positive swabs had significantly higher cumulative risk scores than negative patients. Overall, 62.7% of patients presented ≥1 gap, accounting for 69.5% of 377 total linezolid-days. CONCLUSIONS: Quality gaps in empirical linezolid use affect two-thirds of patients and are associated with nearly 70% of treatment days. Targeted two-level ASP interventions, explicit indication criteria, and systematic de-escalation prompts after negative swabs are warranted.
INTRODUCTION: Bictegravir/emtricitabine/tenofovir alafenamide (B/F/TAF) is a preferred antiretroviral regimen in international guidelines, but long-term real-world data in Latin American people living with HIV (PLWH) are...INTRODUCTION: Bictegravir/emtricitabine/tenofovir alafenamide (B/F/TAF) is a preferred antiretroviral regimen in international guidelines, but long-term real-world data in Latin American people living with HIV (PLWH) are scarce. This study describes 48-month persistence, virological effectiveness, safety and metabolic changes in the Argentine BICTARG cohort. MATERIAL AND METHODS: We conducted an observational, retrospective, open cohort study including treatment-naïve (TN) and treatment-experienced (TE) adults with HIV who initiated B/F/TAF between October 2019 and December 2022 at a large HIV centre. Persistence on B/F/TAF, virological suppression (VS, <50 copies/mL), B/F/TAF-related adverse events (AEs), and metabolic parameters (fasting glucose, cholesterol, and triglycerides) were assessed at 24, 36 and 48 months. RESULTS: Overall, 3,057 PLWH were included: 425 TN (14%) and 2,632 TE (86%). In TN, persistence at 24, 36 and 48 months was 99%, 97% and 95%, and VS rates were 95%, 93% and 90%, respectively, with no AEs reported. In TE, persistence was 98%, 96%, and 88%, and VS rates were 96%, 98%, and 98%; AE rates were ≤0.4%, with no virological failure. Fasting glucose remained unchanged; TN participants showed increases in total, LDL, and HDL cholesterol, whereas in TE participants, lipid levels were stable and triglycerides decreased over time (p<0.001). CONCLUSIONS: In this large Argentine cohort, B/F/TAF demonstrated high persistence, sustained VS, low AE rates and an overall favourable metabolic profile over 48 months in both TN and TE PLWH, providing the first long-term real-world evidence from Latin America.
BACKGROUND: High-risk human papillomaviruses (HR-HPVs) are the main etiological agents of cervical cancer. Although coinfections with multiple HPV types are common, it remains unclear whether certain genotypes tend to as...BACKGROUND: High-risk human papillomaviruses (HR-HPVs) are the main etiological agents of cervical cancer. Although coinfections with multiple HPV types are common, it remains unclear whether certain genotypes tend to associate preferentially or whether these associations occur randomly. In particular, HPV16 is considered the most oncogenic type, but its behavior in the context of mono- versus coinfection is less well defined. METHODS: We retrospectively analyzed cervical cytology and HPV genotyping results from 1,140 women aged 25-65 years. We calculated absolute and relative frequencies of individual HR-HPV types, examined between associations of two-type coinfections, and compared observed versus expected frequencies to assess whether genotype combinations occurred beyond chance. Special attention was given to HPV16, analyzing cytological outcomes in monoinfections versus coinfections. RESULTS: Most HR-HPV coinfections occurred at frequencies consistent with chance, suggesting no preferential interactions between genotypes. HPV16, however, was disproportionately present as a monoinfection. Importantly, no HPV16 monoinfections were significantly more associated with high-grade squamous intraepithelial lesions (HSIL) than HPV16 coinfections (p=0,365). CONCLUSIONS: HPV16 was the most frequent genotype and was more commonly observed as a monoinfection than several other HR-HPV types. However, HPV16 monoinfections were not significantly associated with a higher frequency of HSIL compared with HPV16 coinfections. The observed genotype distribution patterns should be interpreted cautiously within the epidemiological context of opportunistic prevaccination screening.
Solaz-García Á, Sánchez-Herrero H, Valles-Murcia N
… +2 more, Soriano-Ortega MJ, Ruiz-Gaitán A
Rev Esp Quimioter
· 2026 May · PMID 42213064
·
Full text
BACKGROUND: Antifungal resistance is a growing global concern in the context of antimicrobial resistance. Although primary care is the main setting for managing superficial fungal infections, national evidence on antifun...BACKGROUND: Antifungal resistance is a growing global concern in the context of antimicrobial resistance. Although primary care is the main setting for managing superficial fungal infections, national evidence on antifungal consumption in Spain remains limited. This study analyzes the characteristics of antifungal use in Spanish primary care. METHODS: A retrospective observational study was conducted using data from the Primary Care Clinical Database of the Spanish Ministry of Health. The study included individuals assigned to primary care with at least one antifungal dispensation per year between 2019-2024. Consumption was measured as Defined Daily Doses (DDD) per 1,000 inhabitants per day (DHD), following the WHO ATC/DDD methodology. Trends were analyzed by sex, age, municipality size, income level, country of birth, and employment status, using annual percentage change (APC) estimated through joinpoint regression models. RESULTS: From 2019 to 2024, antifungal DHD in Spanish primary care increased significantly overall (APC: 8.4% [6.2-10.5]; p<0.001 for both sexes); the number of individuals with ≥1 dispensation declined in 2020 and then stabilized (APC: 5.3% [2.0-8.6]; p=0.004). Use was consistently higher in women, especially among pensioners (with a widening gap after 2020), unemployed individuals, those with very low income, and those born in Spain; D01A led consumption. Significant APC values were observed across all age, country of birth, employment, municipality size, and income strata, with the largest increases in active workers, small and medium municipalities, males <15 years, and foreign-born. CONCLUSIONS: Systematic monitoring of antifungal consumption in primary care is key to anticipating shifts in epidemiology and guiding antifungal stewardship. This study provides the first nationwide assessment of outpatient antifungal use in Spain from 2019 to 2024, offering critical evidence for public health planning and antimicrobial resistance mitigation.
Tejada S, Clemente A, Socias A
… +11 more, Giglio A, Aranda M, Del Castillo A, Mena J, Ribas JM, Martín L, Llerena KM, Arellano MM, Agudo M, de la Rica R, Borges M
Rev Esp Quimioter
· 2026 May · PMID 42213063
·
Full text
OBJECTIVE: To evaluate the diagnostic accuracy of the biomarkers procalcitonin (PCT), interleukin-6 (IL-6), and mid-regional pro-adrenomedullin (MR-ProADM), individually and in combination, for early detection of sepsis...OBJECTIVE: To evaluate the diagnostic accuracy of the biomarkers procalcitonin (PCT), interleukin-6 (IL-6), and mid-regional pro-adrenomedullin (MR-ProADM), individually and in combination, for early detection of sepsis and septic shock during emergency department (ED) triage. MATERIALS AND METHODS: A retrospective observational study was conducted in adults presenting to the ED with triage levels 2 and 3 between December 2021 and July 2023. Blood samples were collected at admission, prior to any therapeutic intervention. Plasma concentrations of PCT, IL-6, and MR-ProADM were measured using CMIA or ELISA. Diagnostic accuracy was assessed using ROC curves and AUC analysis. RESULTS: A total of 248 patients were included (214 with sepsis and 34 non-septic controls). Simultaneous elevation of PCT, IL-6, and MR-ProADM was observed in 70% of septic patients compared with 3% of controls. Each biomarker showed high diagnostic accuracy for sepsis (AUROC >0.90). The combined assessment increased specificity and was strongly associated with sepsis and septic shock, with progressively higher odds as the number of elevated biomarkers increased. Higher biomarker burden was also associated with indicators of greater clinical severity, including higher SOFA scores and ICU admission. CONCLUSIONS: Combined measurement of PCT, IL-6, and MR-ProADM at ED triage, before therapeutic intervention, improves early identification of patients with sepsis and provides relevant information on initial disease severity. This multiplex platform approach may support clinical prioritization and protocol activation in the ED.
Pasquau J, Candel FJ, Del Pozo JL
… +10 more, Estella Á, Hidalgo-Tenorio C, Ruiz-Ramos J, González-Del-Catillo J, Chueca N, López-Medrano F, Merino E, Anguita-Santos F, Garcia-Vidal C, Salavert-Lletí M
Rev Esp Quimioter
· 2026 May · PMID 42200305
·
Full text
At a time of great concern regarding trends in morbidity and mortality from infections, and mindful of the limitations of our current approaches to combating them, this document sets out a structured programme of proposa...At a time of great concern regarding trends in morbidity and mortality from infections, and mindful of the limitations of our current approaches to combating them, this document sets out a structured programme of proposals aimed at improving, in the short and medium term, the survival of the most at-risk patients with severe infections. These are complementary proposals which, on the one hand, reinforce already established initiatives and, on the other, introduce some novel aspects to the approach to this complex problem. They focus on accelerating, standardising, and refining the clinical diagnosis of severe infection and its microbiological diagnosis and, above all, on improving the effectiveness of antimicrobial treatment, based on its immediate initiation with the most effective treatment available, and with an improved capacity to integrate innovation into all stages and processes. This programme is designed to be implemented within the framework of the Antimicrobial Stewardship Programmes (ASPs) (hence the name ASP-COMPLEX), and requires appropriate dissemination and surveillance policies, alongside a collaborative environment among the multiple stakeholders involved in delivering innovation (experts, ASP teams, healthcare administration, academia, the pharmaceutical industry, etc.).
The management of febrile neutropenia (FN) in oncohematological patients is undergoing a paradigm shift driven by a deeper understanding of patients' pathophysiological heterogeneity, the increasing speed and accuracy of...The management of febrile neutropenia (FN) in oncohematological patients is undergoing a paradigm shift driven by a deeper understanding of patients' pathophysiological heterogeneity, the increasing speed and accuracy of microbiological diagnostics, the emergence of new antibiotics, and the incorporation of predictive artificial intelligence (AI) as a tool to support clinical decision-making. Our objective is to provide an updated and comprehensive overview of the factors influencing antibiotic treatment in FN. We propose that its management should be based on three essential pillars. First, accurate risk stratification for bacterial infection. Second, ensuring that patients receive appropriate empirical antibiotic therapy, tailoring the initial choice according to the results of surveillance cultures from oropharyngeal and/or fecal microbiota. Finally, prioritizing antibiotic choices that preserve intestinal microbiota eubiosis as much as possible. Reducing colonization and overgrowth of facultative aerobic/anaerobic flora (Enterobacteriaceae, non-fermenting Gram-negative bacilli, and spp.) while preserving strict anaerobic flora decreases the risk of bacterial translocation and complications such as graft-versus-host disease (GVHD) after allogeneic hematopoietic stem cell transplantation (allo-HSCT) or loss of CAR-T functionality. This decision model, grounded in objective criteria, aims to balance the need for effective empirical coverage with responsible antibiotic use.
Rodríguez-Leal C, Laguna-Fonseca B, Candel FJ
… +6 more, Rodríguez-Aguirregabiria M, García-Lechuz JM, Galán-Sánchez F, Soriano-Cuesta C, Estella Á, collaborative authors and Medical Societies for the 7th edition of Pneumonia Day (Addenda)
Pneumonia is the leading cause of death from infection in the developed world. In recent years, researchers and healthcare professionals have worked tirelessly to address this issue. Multiresistance is a significant prob...Pneumonia is the leading cause of death from infection in the developed world. In recent years, researchers and healthcare professionals have worked tirelessly to address this issue. Multiresistance is a significant problem in severe pneumonia, so it is crucial to select the appropriate antibiotic at the correct dose and via the appropriate route of administration to ensure effective concentrations in the lung parenchyma. The diagnosis of pneumonia can also be challenging, so it is vital that imaging techniques, biomarkers, and microbiological methods are employed properly. An appropriate therapeutic approach is vital for managing severe community-acquired pneumonia, as it can be complex and is key to achieving optimal clinical outcomes. Nosocomial pneumonia also requires optimal management to avoid therapeutic failure and to improve outcomes, particularly in post-surgery patients. Not only bacteria, but also viruses and fungi can cause severe pneumonia, and appropriate diagnosis is essential for proper treatment. Finally, the correct use of new antimicrobial molecules can help to improve the clinical outcomes of these patients. To provide an update on these issues, a multidisciplinary team of Spanish experts met at the Seventh Annual Pneumonia Day Meeting, which was sponsored by the (GEIPC) of the (SEIMC). This paper summarises the discussions held at the meeting and offers the latest insights on these topics, providing guidance on overcoming the challenges associated with pneumonia management.
Burillo A, Estévez A, Kestler M
… +3 more, Pérez-Granda MJ, Muñoz P, Bouza E
Rev Esp Quimioter
· 2026 Apr · PMID 42011684
·
Full text
The collection and interpretation of blood cultures in paediatric patients require specific considerations that make simple extrapolation from adult recommendations inappropriate. In recent years, the incidence and aetio...The collection and interpretation of blood cultures in paediatric patients require specific considerations that make simple extrapolation from adult recommendations inappropriate. In recent years, the incidence and aetiology of paediatric bacteraemia have evolved, influenced by vaccination programmes, improved infection prevention strategies, and increasing clinical complexity, particularly in neonatal, oncohaematological, and intensive care settings. Clinical guidelines recommend blood cultures in neonates and infants with fever without a focus in children with sepsis or shock, with immunosuppression, suspected endovascular infection, meningitis, osteoarticular infections, or severe community-acquired pneumonia. Conversely, routine use is discouraged in clearly viral infections and in mild cases in previously healthy children. Available evidence consistently identifies the volume of blood inoculated as the main determinant of diagnostic performance, and this should be adjusted for age and weight. Obtaining one or two appropriately indicated peripheral blood culture sets, together with proper antisepsis, reduces contamination and improves clinical interpretation. Whenever feasible, both aerobic and anaerobic bottles should be included, given their complementary diagnostic yield. There is no robust evidence that paediatric bottles with smaller broth volumes provide substantial advantages over standard bottles when adequate blood volumes are inoculated. Importantly, no evidence demonstrates that the type of bottle or automated system used influences hospital stay, clinical outcomes, or mortality. This article presents an evidence-informed perspective that integrates current literature with expert clinical judgment, derived from more than four decades of experience at a high-complexity tertiary-care hospital.
Rodríguez-Villar D, Cárdenas-Soriano MP, Climent-Martínez N
… +7 more, Pedraza-Flechas AM, Rodríguez-Villar S, Zamorano-Méndez P, Villar-Del-Campo MC, SanRomán-Montero JM, Durán-Poveda M, Rodríguez-Caravaca G
Rev Esp Quimioter
· 2026 Mar · PMID 41892944
·
Full text
BACKGROUND: Healthcare-associated infections (HAIs) represent the most common adverse event among hospitalized patients. The aim of this study was to assess Surgical Site Infection (SSI) incidence in hysterectomies, and...BACKGROUND: Healthcare-associated infections (HAIs) represent the most common adverse event among hospitalized patients. The aim of this study was to assess Surgical Site Infection (SSI) incidence in hysterectomies, and the related risk factors. MATERIALS AND METHODS: A prospective cohort study on patients undergoing abdominal or vaginal hysterectomy was carried out. We assessed the incidence of SSIs according to CDC/NHSN criteria. Patients' demographic and clinical characteristics were described. Univariate and multivariate analyses were conducted to find independently associated risk factors for SSI. The association between risk factors and SSI incidence was assessed by reference to the adjusted odds ratio (OR). RESULTS: The study covered a total of 1,154 women who underwent abdominal (47.7%) or vaginal (52.3%) hysterectomy. Patients' overall mean age was 54.7 years (SD=13.2). Overall SSI incidence at the end of follow-up was 2.5% (n=29), 1.9% in abdominal hysterectomies and 3.4% in vaginal hysterectomies (p>0.05). We found diabetes mellitus (OR: 2.9, 95% CI: 1.1-8.0, p=0.04) and cancer (OR: 3.7, 95% CI: 1.4-9.6, p=0.007) independently associated with SSI incidence. CONCLUSIONS: Vaginal hysterectomies accounted for 52.3%. Global incidence of SSI reached 2.5% and was in the lowest rank of the published evidence. Diabetes mellitus and cancer were risk factors related to SSIs.
Caeiro-Martínez L, Brandariz-Núñez D, Albiñana-Pérez MS
… +4 more, Alemparte-Pardavila E, Mourelo-Fariña M, Gutiérrez-Urbón JM, Margusino-Framiñán L
Rev Esp Quimioter
· 2026 Mar · PMID 41854481
·
Full text
INTRODUCTION: Adjunctive intravenous non-specific immunoglobulin (IVIG) is used in the management of streptococcal toxic shock syndrome, although supporting evidence remains limited. The primary objective of this study w...INTRODUCTION: Adjunctive intravenous non-specific immunoglobulin (IVIG) is used in the management of streptococcal toxic shock syndrome, although supporting evidence remains limited. The primary objective of this study was to describe the use of IVIG in patients with invasive infection. MATERIALS AND METHODS: We conducted a retrospective observational study over 11 years, including patients diagnosed with invasive infection who received at least one dose of IVIG as adjunctive therapy. RESULTS: Twenty-three patients were included, with a mean age of 63.2 ± 16.3 years; 47.8% were male. Most patients (73.9%) developed septic shock and STSS, requiring admission to intensive care units. The mean Sequential Organ Failure Assessment (SOFA) score was 9.1 ± 4.9. High-dose IVIG (2.0 ± 0.2 g/kg) was administered promptly, with a mean time to first infusion of 0.26 ± 0.47 days from admission. In-hospital mortality was 21.7% overall and 29.4% among STSS patients. Non-survivors had significantly higher disease severity and were more likely to develop hepatic dysfunction and require continuous renal replacement therapy (CRRT). Two patients (8.7%) experienced IVIG-related adverse events, both of which were mild. CONCLUSION: Early and standardized high-dose IVIG administration, in combination with prompt targeted antibiotic therapy and intensive supportive care, was associated with mortality rates similar to, or lower than, those previously reported. Initial disease severity, hepatic dysfunction, and need for CRRT were identified as predictors of mortality. IVIG demonstrated a favorable safety profile.
Rev Esp Quimioter
· 2026 Mar · PMID 41811471
·
Full text
Delafloxacin is a novel anionic fluoroquinolone with a different chemical structure from currently marketed fluoroquinolones, which gives it distinct physicochemical characteristics, being active in both acidic and neutr...Delafloxacin is a novel anionic fluoroquinolone with a different chemical structure from currently marketed fluoroquinolones, which gives it distinct physicochemical characteristics, being active in both acidic and neutral environments. Delafloxacin is also unique in showing a dual-targeted equipotent inhibition of the essential bacterial enzymes DNA gyrase and topoisomerase IV, which may explain the very low frequencies of spontaneous mutations . It shows potent activity against a broad spectrum of Gram-negative bacteria, including some fluoroquinolone-resistant strains, and increased efficiency against Gram-positive bacteria, including methicillin-resistant , although it is always necessary to determine the activity of delafloxacin against fluoroquinolone-resistant isolates. Delafloxacin exhibits linear pharmacokinetics, a wide volume of distribution, and a concentration-dependent pattern of antimicrobial killing, a property that allows the use of high doses for greater effectiveness in some difficult-to-treat infections. Delafloxacin is available for clinical use in oral and intravenous formulations and has been approved for the treatment of acute bacterial skin and skin-structure infections and community-acquired bacterial pneumonia based on the results from phase II and III clinical trials. Overall, delafloxacin has been well tolerated and has a low profile of drug-drug interactions. Its activity in local acidic environments and biofilms could play a role in the treatment of biofilm-related infections such as osteoarticular and medical device-associated infections, and due to its broad spectrum, it can also be useful in polymicrobial infections. Delafloxacin is an interesting new addition to the therapeutic arsenal against common and difficult-to-treat infections.