Rev Esp Quimioter 2009;22(1):10-19

Multicenter national survey on infection management in patients with penicillin allergy

R. Serrano ,  J. A. Capdevila ,  J. Mensa y J. Barberán ,  R. Oltra

   

Introduction. Beta-lactam antibiotics are widely prescribed to treat many infections because of efficacy, spectrum and safety. Their use is limited in patients with resistant microbial agents and in those with a history of penicillin allergy (HPA) because of cross-reactivity risk. Accurate clinical assessment of possible HPA requires specialized resources not always available in clinical practice. We intended to get to know the opinion of Spanish physicians about frequency and methods of evaluation of the patients with HPA as well as the preferences in the use of antimicrobial alternatives for common infectious diseases in patients with HPA.

Methods. Multicentric cross-sectional descriptive study ran by the Infectious Diseases Study Group of the Spanish Society for Internal Medicine based on the accomplishment of a survey of 10 questions of opinion to specialist doctors who work in Spanish medical centers.

Results. A total of 311 doctors responded to the survey (92.2% Internal Medicine specialists) distributed by all the Spanish territory. An average of 10.7% of patients self-reported having HPA although only an average of 10.8 % of them gave documentation on the matter. Patients were sent for specific allergy tests in an average of 33.6 %. Desensitization treatments were performed in 4.3 % of cases. The preferences for alternative antibiotic therapy to beta-lactan widely varied according to the infectious picture and the communitarian or nosocomial origin, and they included quinolones, macrolides, glycopeptides, lincosamides, oxazolidinones and tigecycline.

Conclusions. Perception about frequency and evaluation of patients with HPA is very variable, but in more than half the cases it is above 10 % of the patients. Yet, only one third are sent for in-depth study for allergy confirmation, and less than 5% are desensitized. Nosocomial infections and the possibility of multiresistant bacteria make substantially difficult the management of patients with HPA.

Key words:Beta-lactam antibiotics. Hypersensibility. Drug allergies. Tigecycline. Desensitization treatment.   

Rev Esp Quimioter 2009;22(1):10-19 [pdf]   

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Rev Esp Quimioter 2009;22(1):4-9

Management in the emergency room of patients requiring hospital treatment of community-acquired pneumonia

D. Martínez ,  V. Álvarez Rodríguez ,  M. Martínez Ortiz de Zárate ,  M. Rivas ,  M. J. Giménez ,  L. Aguilar ,  M. J. Ruiz Polaina ,  J. Barberán ,  J. Prieto ,  on behalf of the CAPEM study Group 

  

Introduction. To identify factors influencing decisions in initial management of community-acquired pneumonia (CAP) admitted to hospital through Emergency departments.

Methods. Records of CAP adult patients admitted to 24 Spanish hospitals in January-Mars 2003 were reviewed. Patients sent for ambulatory treatment were excluded.

Results. 341 patients (67.0 ± 24.6 years; 65.3 % males) were included; 39 % were taking antibiotics at attendance. PSI was (% patients): I-II (19.7 %), III (14.7 %), and IV-V (65.6 %). Comorbidities were: COPD (37.2 %), heart disease (24.6 %), hypertension (17 %), diabetes mellitus (10.8 %), and malignancies (10 %). Pneumococcal/Legionella urinary antigens were performed in 34.0 %/42.2 % patients. Fewer (p ≤ 0.006) rapid tests were performed in class IV-V (p = 0.001), with higher (p ≤ 0.01) pneumococcal positive results in class V. Initial treatment was fluoroquinolone (37.5 %), beta-lactam + macrolide (26.4 %), beta-lactam (22.9 %), macrolide (4.7 %), and others (8.5 %). Patients referred to Internal Medicine had higher heart disease (p = 0.06) and hypertension (p = 0.001) as comorbidity than those at Short-Stay Units or Pneumology. COPD patients were equally distributed between Internal Medicine and Pneumology, with differences vs. Short-Stay Units.

Conclusions. Rapid diagnostic tests were underused, maybe due to broad empirical treatments covering drug-resistant pneumococci and L. pneumophila (regardless PSI and comorbidity). Presence of comorbidities or positive results in rapid diagnostic tests seems to influence the medical ward to which the patient is referred to, but not initial treatment.

  

Key Words: Legionella urinary test. Pneumococcal urinary test. Community-acquired pneumonia. Empirical treatment. Emergency room.

Rev Esp Quimioter 2009;22(1):4-9  [pdf]   

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