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Rev Esp Quimioter 2019; 32(5):410-425

Clinical practice update of antifungal prophylaxis in immunocompromised children 

JOSÉ TOMÁS RAMOS, CONCEPCIÓN ALBA ROMERO, SYLVIA BELDA, FRANCISCO JAVIER CANDEL, BEGOÑA CARAZO GALLEGO, AURORA FERNÁNDEZ-POLO, LAURA FERRERAS ANTOLÍN, CARMEN GARRIDO COLINO, MARÍA LUISA NAVARRO, OLAF NETH, PETER OLBRICH, ELENA RINCÓN-LÓPEZ, JESÚS RUIZ CONTRERAS, PERE SOLER-PALACÍN, ON BEHALF OF THE FUNGAL INFECTION STUDY GROUP OF SPANISH SOCIETY OF PAEDIATRIC INFECTIOUS DISEASE (SEIP); TRASLATIONAL RESEARCH NETWORK IN PEDIATRIC INFECTIOUS DISEASES (RITIP)

Due to the rise in the number and types of immunosuppressed patients, invasive fungal infections (IFI) are an increasing and major cause of morbidity and mortality in immunocompromised adults and children. There is a broad group of pediatric patients at risk for IFI in whom primary and/or secondary antifungal prophylaxis (AFP) should be considered despite scant evidence. Pediatric groups at risk for IFI includes extremely premature infants in some settings, while in high-risk children with cancer receiving chemotherapy or undergoing haematopoietic stem cell transplantation (HCT), AFP against yeast and moulds is usually recommended. For solid organ transplanted, children, prophylaxis depends on the type of transplant and associated risk factors. In children with primary or acquired immunodeficiency such as HIV or long-term immunosuppressive treatment, AFP depends on the type of immunodeficiency and the degree of immunosuppression. Chronic granulomatous disease is associated with a particular high-risk of IFI and anti-mould prophylaxis is always indicated. In contrast, AFP is not generally recommended in children with long stay in intensive care units. The choice of AFP is limited by the approval of antifungal agents in different age groups and by their pharmacokinetics characteristics. This document aims to review current available information on AFP in children and to provide a comprehensive proposal for each type of patient.

Rev Esp Quimioter 2019; 32(5):410-425 [Full-text PDF]

 

 

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Rev Esp Quimioter 2019; 32(Suppl. 2):69-72

Infection in the process of organ donation  

OSCAR LEN ABAD

The difference between demand and supply has led transplant organizations to look for marginal donors, including those who could transmit infections to their recipients. This potential risk must be thoroughly evaluated to optimize the use of such organs without increasing the incidence of graft dysfunction and the morbidity and mortality of the recipient. This article aims to provide a general and up-to-date overview of this issue.

Rev Esp Quimioter 2019; 32(Suppl. 2):69-72 [Full-text PDF]

 

 

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Rev Esp Quimioter 2019; 32(Suppl. 2):63-68

Assessment of latent infections in patients receiving biological therapies  

MARIO FERNÁNDEZ-RUIZ

The use of biological (or targeted) therapies constitutes a major advance in the management of autoinflammatory and malignant diseases. However, due to the selective effect of these agents on the host’s immune response, reactivation of certain pathogens that cause latent infection is to be expected. The most relevant concern is the risk of reactivation of latent tuberculosis infection (LTBI) and progression to active tuberculosis among patients treated with agents targeting tumor necrosis factor (TNF)-α. Systematic screening for LTBI at base-line with appropriate initiation of antituberculous treatment, if needed, is mandatory in this patient population as risk minimization strategy. In addition, reactivation of hepatitis B virus induced by B-cell-depleting (anti-CD20) and anti-TNF-α agents should be also prevented among HBsAg-positive patients and those with isolated anti-HBc IgG positivity (risk of “occult HBV infection”). The present review summarizes available evidence regarding the risk of reactivation of these latent infections induced by newer biological agents, as well as the recommendations included in the most recent guidelines..

Rev Esp Quimioter 2019; 32(Suppl. 2):63-68 [Full-text PDF]

 

 

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Rev Esp Quimioter 2019; 32(Suppl. 2):59-62

Prophylaxis of mould infections  

ESTELA MORENO-GARCÍA, MARIANA CHUMBITA, PEDRO PUERTA-ALCALDE, CELIA CARDOZO, CAROLINA GARCIA-VIDAL

Invasive fungal infection continues to be an important cause of morbidity and mortality in haematological patients. Antifungal prophylaxis in these patients has remarkably increased survival since its introduction. In recent years, new antifungals have been on the rise, being more effective and having less toxicity than previous ones. Nonetheless, the number of patients at risk of fungal infection has also been increasing due to the continuous appearance of new immunosuppressive treatments. As a result of such, we face a changing situation that requires constant updating.

Rev Esp Quimioter 2019; 32(Suppl. 2):59-62 [Full-text PDF]

 

 

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Rev Esp Quimioter 2019; 32(Suppl. 2):55-58

Update on the management of febrile neutropenia in hematologic patients  

FRANCESC ESCRIHUELA-VIDAL. JÚLIA LAPORTE, ADAIA ALBASANZ-PUIG, CARLOTA GUDIOL

Febrile neutropenia is a common complication in patients with hematologic malignancies receiving chemotherapy, and is associated with high morbidity and mortality. Infections caused by multidrug-resistant bacteria represent a therapeutic challenge in this high-risk patient population, since inadequate initial empirical antibiotic treatment can seriously compromise prognosis. Besides, reducing antimicrobial exposure is a cornerstone in the fight against resistance.

Rev Esp Quimioter 2019; 32(Suppl. 2):55-58 [Full-text PDF]

 

 

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Rev Esp Quimioter 2019; 32(Suppl. 2):47-54

Doctor, my patient has CDI and should continue to receive antibiotics. The (unresolved) risk of recurrent CDI  

IVÁN CASTRO, MARIONA TASIAS, EVA CALABUIG, MIGUEL SALAVERT

Recurrence rate ranges from 12% to 40% of all cases of Clostridium difficile infection (CDI) and proposes an exceptional clinical challenge. Conventionally, treatment options of CDI have been limited to regimes of established antibiotics (eg, pulsed/tapered vancomycin) or “improvised” alternative antibiotics (eg. teicoplanin, tigecycline, nitazoxanide or rifaximin) occasionally even in combination, but faecal microbiota transplantation is emerging as a useful and quite safe alternative. In recent years, promising new strategies have emerged for effective prevention of recurrent CDI (rCDI) including new an-timicrobials (eg, fidaxomicin) and monoclonal antibodies (eg, bezlotoxumab). Despite promising progress in this area, difficulties remain for making the best use of these resources due to uncertainty over patient selection. This positioning review describes the current epidemiology of rCDI, its clinical impact and risk factors, some of the measures used for treating and preventing rCDI, and some of the emerging treatment options. It then describes some of the barriers that need to be overcome.

Rev Esp Quimioter 2019; 32(Suppl. 2):47-54 [Full-text PDF]

 

 

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Rev Esp Quimioter 2019; 32(Suppl. 2):42-46

Stewardship in sepsis  

JOSE L. DEL POZO

Sepsis is the major cause of mortality from any infectious disease worldwide. The goals of antimicrobial stewardship are to achieve optimum clinical outcomes and to ensure cost effectiveness and minimum unintended consequences, including toxic effects, selection of pathogenic organisms, and resistance. The combination of inadequate diagnostic criteria for sepsis with the extraordinary time pressure to provide broad-spectrum antimicrobial therapy is troubling from a stewardship perspective. Use of empirical therapy according to guidelines, de-escalation of therapy, switch from intravenous to oral therapy, therapeutic drug monitoring, use of a list of restricted antibiotics, and bedside consultation can lead to significant benefits for clinical outcomes, adverse events, and costs.

Rev Esp Quimioter 2019; 32(Suppl. 2):42-46 [Full-text PDF]

 

 

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Rev Esp Quimioter 2019; 32(Suppl. 2):38-41

Practical approach to the management of catheter-related bloodstream infection  

Mª LUISA CANTÓN-BULNES, JOSÉ GARNACHO-MONTERO

Catheter-related bloodstream infections (CRBSI) is a common cause of nosocomial infection associated resulting in substantial morbidity, mortality, increased length of hospital stays and health-care costs. New clinical practice guidelines for the management of adults with CRBSI have been published in 2018 by the Spanish Society of Infectious Diseases and Clinical Microbiology (SEIMC) and the Spanish Society of Intensive and Critical Care Medicine and Coronary Units (SEMICYUC). This review focuses on updated recommendations for the diagnosis and management of CRBSI in adults. Prevention of CRBSI is excluded. Our aim is to show some of the key aspects concerning the following topics: diagnosis, empirical and targeted therapy.

Rev Esp Quimioter 2019; 32(Suppl. 2):38-41 [Full-text PDF]

 

 

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Rev Esp Quimioter 2019; 32(Suppl. 2):35-37

The pharmacodynamic bases of the prescription of antimicrobials  

JOSÉ RAMÓN AZANZA PEREA

In the past, the dose of an antibiotic was chosen, always from among those that were well tolerated, by considering those with the ability to exceed the MIC of bacteria in plasma. This approach, which has still not widely changed, is contrast-ed with the pharmacokinetic and pharmacodynamic (PK/PD) relationships, which indicate that the efficacy of antibiotics is directly related to parameters that relate the sequence of con-centrations over time with a parameter of the MIC effect in vitro. Until now, three types of PK/PD relationships have been established for antibiotics: the inhibitory coefficient (Cmax/MIC), the efficacy time (T>CMI) and the relationship between the exposure of the drug and the MIC (AUC/MIC).

Rev Esp Quimioter 2019; 32(Suppl. 2):35-37 [Full-text PDF]

 

 

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Rev Esp Quimioter 2019; 32(Suppl. 2):32-34

Antibiotic selection in the treatment of acute invasive infections by Pseudomonas aeruginosa  

CELIA CARDOZO, VERÓNICA RICO, DAIANA AGÜERO, ALEX SORIANO

Pseudomonas aeruginosa is characterized by an important intrinsic resistance to antibiotics and it possess an extraordinary ability to develop resistance to nearly all available antimicrobials through selection of mutations. We review some of the pharmacodynamic principles of antibiotics predicting efficacy, clinical experience with monotherapy and combination therapy, and principles for antibiotic treatment for empirical and directed treatment of P. aeruginosa invasive infections.

Rev Esp Quimioter 2019; 32(Suppl. 2):32-34 [Full-text PDF]

 

 

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