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Rev Esp Quimioter 2022;35(Suppl.1):25-27

Ceftobiprole medocaril

RAÚL MÉNDEZ, ANA LATORRE, PAULA GONZÁLEZ-JIMÉNEZ

Published: 22 April 2022

http://www.doi.org/10.37201/req/s01.05.2022

Ceftobiprole medocaril is a broad-spectrum 5th-generation cephalosporin with activity against Gram-positives such as methicillin-resistant Staphylococcus aureus and penicillin-resistant Streptococcus pneumoniae, and against Gram-negatives such as Pseudomonas aeruginosa. The recommended dose is 500 mg every 8 h in 2-hour infusions. Various clinical trials have demonstrated its usefulness in the treatment of community-acquired pneumonia and nosocomial pneumonia, with the exception of ventilator-associated pneumonia. In summary, it is a very useful antibiotic for the treatment of pneumonia.

Rev Esp Quimioter 2022; 35(Suppl. 1):25-27 [Full-text PDF]


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Rev Esp Quimioter 2022;35(Suppl.1):21-24

Usefulness of thoracic ultrasound for diagnosis and follow-up of pneumonia

JAVIER PÉREZ PALLARÉS, FRANCISCA LERENAS BERNAL, MARIA DEL ROSARIO CABELLO JABALQUINTO, ALEXANDER ALI JIMÉNEZ ROMERO

Published: 22 April 2022

http://www.doi.org/10.37201/req/s01.04.2022

Classically the diagnosis of both bacterial and viral pneumonias was made with chest radiology, later the use of chest CT was implemented, however in recent years lung ultrasound has become very important in the diagnosis of pulmonary pathology and increased in pandemic by SARS-CoV-2, due to the practicality of being done at the patient’s bedside, the ability to be reproducible, and the decrease in radiation exposure to patients.

Rev Esp Quimioter 2022; 35(Suppl. 1):21-24 [Full-text PDF]


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Rev Esp Quimioter 2022;35(Suppl.1):15-20

Value of syndromic panels in the management of severe community-acquired pneumonia

ALMUDENA BURILLO, FRANCISCO JAVIER CANDEL, ANDRÉS CANUT-BLASCO

Published: 22 April 2022

http://www.doi.org/10.37201/req/s01.03.2022

Community-acquired pneumonia requiring hospital admission is a prevalent and potentially serious infection, especially in high-risk patients (e.g., those requiring ICU admission or immunocompromised). International guidelines recommend early aetiological diagnosis to improve prognosis and reduce mortality. Syndromic panels that detect causative pathogens by molecular methods are here to stay. They are highly sensitive and specific for detecting the targets included in the test. A growing number of studies measuring their clinical impact have observed increased treatment appropriateness and decreased turnaround time to aetiological diagnosis, need for admission, length of hospital stay, days of isolation, adverse effects of medication and hospital costs. Its use is recommended a) per a pre-established protocol on making the diagnosis and managing the patient, b) together with an antimicrobial stewardship programme involving both the Microbiology Service and the clinicians responsible for the patient, and c) the final evaluation of the whole process. However, we recall that microbiological diagnosis with traditional methods remains mandatory due to the possibility that the aetiological agent is not included among the molecular targets and to determine the antimicrobial susceptibility of the pathogens detected.

Rev Esp Quimioter 2022; 35(Suppl. 1):15-20 [Full-text PDF]


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Rev Esp Quimioter 2022;35(Suppl.1):6-14

Urgent need for a rapid microbiological diagnosis in critically ill pneumonia

FERNANDO MARTÍNEZ SAGASTI, MARÍA CALLE ROMERO, MONTSERRAT RODRÍGUEZ GÓMEZ, PATRICIA ALONSO MARTÍNEZ SANDRA, CATALINA GARCÍA-PERROTE

Published: 22 April 2022

http://www.doi.org/10.37201/req/s01.02.2022

Severe lower respiratory tract infection is a common issue in Intensive Care Units that causes significant morbidity and mortality. The traditional diagnostic-therapeutic approach has been grounded on taking respiratory samples and/or blood cultures as soon as possible and starting empirical antibiotic therapy addressed to cover most likely pathogens based on the presence of the patient’s risk factors for certain microorganisms, while waiting for the culture results in the following 48-72 hours to adequate the antibiotic treatment to the sensitivity profile of the isolated pathogen. Unfortunately, this strategy leads to use broad-spectrum antibiotics more times than necessary and does not prevent possible therapeutic failures. The recent development of rapid molecular diagnostic techniques, based on real time polymerase chain reaction (RT-PCR), makes it possible to determine the causative agent and its main resistance pattern between 1 and 5 hours after sampling (depending on each technique), with high precision, some of them reaching a negative predictive value greater than 98%, facilitating the very early withdrawal of unnecessary broad-spectrum antibiotics. Its high sensitivity can also detect unsuspected pathogens based on risk factors, allowing adequate treatment in the first hours of stay. This short review discusses the potential usefulness of these techniques in critically ill patients with lower respiratory tract infection and advocates their immediate implementation in clinical practice

Rev Esp Quimioter 2022; 35(Suppl. 1):6-14 [Full-text PDF]


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Rev Esp Quimioter 2022;35(Suppl.1):2-5

Usefulness of monocyte distribution width (MDW) as a sepsis biomarker

SARA LAÍNEZ MARTÍNEZ, JUAN GONZÁLEZ DEL CASTILLO

Published: 22 April 2022

http://www.doi.org/10.37201/req/s01.01.2022

Sepsis is one of the main causes of mortality in the emergency department (ED), due to the fact that signs and symptoms are common to other acute diseases, and this can result in delayed detection. This diagnostic complexity has a huge impact on an entity in which early recognition determined treatment, as wells as enhance the patient’s prognosis. Therefore, it is crucial to improve early identification. Different analytical tools arise from this approach, such as biomarkers: procalcitonin, C-reactive protein or MR-proadrenomedullin. In this review we will focus on a newer biomarker, the monocyte distribution width. The main objectives are to evaluate the usefulness of monocyte distribution width (MDW) in sepsis identification in ED, its limitations, and to compare it with other biomarkers

Rev Esp Quimioter 2022; 35(Suppl. 1):2-5 [Full-text PDF]


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Rev Esp Quimioter 2022; 35(3): 265-272

Clinical and epidemiologic description of a severe outbreak of Salmonellosis in an urban nursery school

ANA RUBIO GRANDA, MARÍA FERNÁNDEZ MIAJA, SARA DELGADO NICOLÁS, ANA FERNÁNDEZ IBÁÑEZ, Mª EUGENIA LLANEZA VELASCO, Mª AGUSTINA ALONSO ÁLVAREZ

Published: 18 April 2022

http://www.doi.org/10.37201/req/134.2021

Objectives. We describe clinically and epidemiologically an outbreak of gastrointestinal infection by Salmonella enterica ser. (serotype) Enteritidis in an urban infant school, which led to high morbidity and significant social alarm. The immediate communication, as well as the adequate study of the outbreak, in both aspects, allowed identifying the pathogen and establishing control measures in a reasonable period of time. Controversial aspects such as the indication of antibiotherapy or the moment of closing the center are discussed.
Methods. We retrospectively collected clinical, analytical and epidemiological information and we reviewed the
methodology of the outbreak study and its results.
Results. A total of 57 children (3-45 months), were affected and had microbiological confirmation. Diarrhea and fever were the main symptoms. 74% went to the hospital and 37% were admitted (mean stay 3.3 days). Factors associated with admission were: dehydration, significant elevation of acute phase reactants and coagulopathy. Twelve patients received parenteral cefotaxime. There were 2 complications: 1 bacteremia and 1 readmission. The initial suspicion of the origin of the outbreak was food, but the analysis of the control samples was negative. Five workers were positive (2 symptomatic). Epidemiologic Surveillance concluded that the probable origin of the outbreak was an asymptomatic carrier and improper diapers handling. The center was closed for 8 days. Cleaning and disinfection measures were carried out, as well as instruction on diaper changing, and the carriers were followed.
Conclusions. Clustering in time and space of cases should be reported immediately for early control of the outbreak. Children may present severe forms of Salmonella gastroenteritis.

Rev Esp Quimioter 2022; 35(3): 265-272 [Texto completo PDF]


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Rev Esp Quimioter 2022; 35(4):344-356

New predictive models of bacteremia in the emergency department: a step forward

AGUSTÍN JULIÁN-JIMÉNEZ, RAFAEL RUBIO-DÍAZ, JUAN GONZÁLEZ DEL CASTILLO, FRANCISCO JAVIER CANDEL GONZÁLEZ, ON BEHALF OF GRUPO INFURG-SEMES (GRUPO DE ESTUDIO DE INFECCIONES DE LA SOCIEDAD ESPAÑOLA DE MEDICINA DE URGENCIAS Y EMERGENCIAS)

Published: 13 April 2022

http://www.doi.org/10.37201/req/015.2022

The care of patients with a suspected infectious process in hospital emergency department (ED) has increased in the last decade to account for around 15-20% of all daily care. In the initial evaluation of these patients, samples are taken for the different microbiological studies in 45% of the cases, where obtaining blood cultures (BC) predominates, in 14.6% of all of them. The diagnostic yield of these BC is highly variable (2-20%). The most frequent suspected or confirmed foci or infectious processes of true bacteremia (TB) in the ED are urinary tract infection (45%) and respiratory infection (25%). For all these reasons, the suspicion and confirmation of TB has a relevant diagnostic and prognostic significance and requires changing some of the most important decisions to be made in the ED. Among others, indicate discharge or admission, extract BC and administer the appropriate and early antimicrobial. The intention of this review is to highlight the scientific evidence published in the last five years, clarify the current controversies and compare the ability to predict bacteremia of the latest predictive models published since 2017 with those already existing on that date, year in which a review was published that left open the proposal to continue searching for a model with adequate performance for ED. And so, based on it, generate different recommendations that help define the role that these models or scales can have in improving the indication for obtaining BC, as well as in the immediate making of other diagnostic-therapeutic decisions (administration early and appropriate antibiotic treatment, request for complementary tudies and other microbiological samples, intensity of hemodynamic support, need for admission, etc.).

Rev Esp Quimioter 2022; 35(4):344-356 [Full-text PDF]


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Rev Esp Quimioter 2022; 35(3): 288-292

High incidence of COVID-19 at nursing homes in Madrid, Spain, despite preventive measures

PILAR ESCRIBANO, MARÍA JESÚS PÉREZ-GRANDA, ROBERTO ALONSO, PILAR CATALÁN, LUIS ALCALÁ, JOSÉ ANTONIO SERRA-REXARCH, LAURA OSUNA, ALEJANDRO FERNÁNDEZ, AURORA CONTI, ALBERTO CASTELLANOS, JESÚS GUINEA, PATRICIA MUÑOZ, EMILIO BOUZA

Published: 11 April 2022

http://www.doi.org/10.37201/req/008.2022

Objective. To assess the impact of COVID-19 at nine nursing homes in Madrid, Spain, during the first wave of COVID-19 infection and lockdown period when preventive measures were taken to avoid transmission among residents.
Methods. Nine hundred forty-two residents and 846 staff members from nine nursing homes participated in the study (April 18 to June 20, 2020). All participants were tested for SARS-CoV-2 in the nasopharynx by PCR and for IgG antibodies detection. Microbiological status at sampling was defined as active infection (positive PCR ± presence of antibodies), past infection (negative PCR + presence of antibodies), or naïve participants (negative PCR + absence of antibodies).
Results. Laboratory results helped classify the residents as having active infection (n=224; 23.8%), past infection (n=462; 49.1%), or being naïve (n=256; 27.1%); staff members were actively infected (n=127; 15.1%), had had a past infection (n=290; 34.2%), or were naïve (n=429; 50.7%). Overall, the percentage of participants with COVID-19 was significantly higher in residents than in staff members (72.8% vs 49.2%; P=0.001). The clinical situation of residents vs staff at sampling was as follows: acute manifestations compatible with COVID-19 (7.3% vs 3.9%; P<0.01) and no manifestations of infection (92.7% vs 96.0%; P<0.01). A large proportion of both asymptomatic and symptomatic residents (69.4% vs 86.6%; P=0.015) had positive PCR results (mostly alongside positive IgG determinations).
Conclusions. COVID-19 affects 75% of the residents in nursing homes in Madrid. The high impact in these settings, despite the strict restrictions adopted during the lockdown, demonstrates the ability of SARS-CoV-2 to cause outbreaks.

Rev Esp Quimioter 2022; 35(3): 288-292 [Full-text PDF]


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Rev Esp Quimioter 2022; 35(3): 284-287

Evaluation of a lateral flow immunoassay to detect CTX-M extended-spectrum β-lactamases (ESBL) directly from positive blood cultures for its potential use in Antimicrobial Stewardship programs

EMILIO CENDEJAS-BUENO, MARÍA DEL PILAR ROMERO-GÓMEZ, IKER FALCES-ROMERO, ALFONSO ARANDA-DIAZ, DIANA GARCÍA-BALLESTEROS, JESÚS MINGORANCE, JULIO GARCÍA-RODRÍGUEZ

Published: 31 March 2022

http://www.doi.org/10.37201/req/164.2021

Background. Bloodstream infections (BSI) caused by extended-spectrum beta-lactamases Enterobacteriaceae (ESBL-E) are associated with high rates of treatment failure and increased mortality, especially when appropriate antimicrobial therapy is delayed. Our aim was to evaluate the anticipation of ESBLs detection and the potential improvement of the time response of the Vitek 2 System (BioMérieux; France).
Methods. We compared this lateral flow immunoassay when used directly on fluid from positive blood cultures to the VITEK2 AST system. We evaluated 80 isolates, 61 tested directly on fluid from positive blood cultures and 19 tested on fluid from blood cultures spiked with known ESBL positive and negative organisms.
Results. The concordance between the CTX-LFIA and the reference method (Vitek 2) had a Cohen´s Kappa coefficient of 0.97, indicating a particularly good correlation between both compared methods.
Conclusion. This lateral flow immunoassay can be more rapid than the Vitek 2 for earlier presumptive identification of CTX- M ESBLs and can be useful to anticipate results and the adjustment of antimicrobial therapy.

Rev Esp Quimioter 2022; 35(3): 284-287 [Full-text PDF]


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Rev Esp Quimioter 2022; 35(3): 241-248

Effectiveness of cell culture-based influenza vaccines compared with egg-based vaccines: What does the literature say?

JAVIER ÁLVAREZ ALDEÁN, IGNACIO SALAMANCA, DANIEL OCAÑA, JOSÉ LUIS BARRANCO, STEFAN WALTER

Published: 18 March 2022

http://www.doi.org/10.37201/req/117.2021

Introduction. Influenza vaccination is an effective way of reducing the burden of seasonal influenza. Chicken egg embryos are the most common source of influenza vaccines, but cell culture production has emerged as an alternative that could be advantageous. This article reviews the available literature on the efficacy/effectiveness of cell culture-based influenza vaccines compared with egg-based vaccines.
Methods. We conducted a review of the actual literature and analyzed those studies comparing the effectiveness of cell culture-based and egg-based vaccines in the last ten years.
Results. Eight studies were analyzed; 1 was a clinical trial and 7 were retrospective cohort studies. The clinical trial found no significant differences in the efficacy of both vaccines with respect to placebo. The results of the observational studies were inconsistent and relative effectiveness varied among studies, even though most were performed during the same season, and in some cases, in the same region and using the same data records. Furthermore, in most studies, the comparisons between vaccines were not statistically significant.
Conclusions. There is insufficient evidence that cell culture-based vaccines are superior to egg-based vaccines in terms of efficacy/effectiveness.

Rev Esp Quimioter 2022; 35(3): 241-248 [Full-text PDF]


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