MARÍA NIEVES CARMONA TELLO, LAURA SUÁREZ HORMIGA, MARGARITA BOLAÑOS RIVERO, ISABEL DE MIGUEL MARTÍNEZ
Published: 9 February 2022
LETTER TO THE EDITOR
http://www.doi.org/10.37201/req/137.2021
Rev Esp Quimioter 2022; 35(2):227-228 [Texto completo PDF]
MAXIMILIEN NEUKIRCH, ROCÍO SÁNCHEZ-RUIZ, JOSÉ MARÍA NAVARRO-MARÍ, JOSÉ GUTIÉRREZ-FERNÁNDEZ
Published: 7 February 2022
LETTER TO THE EDITOR
http://www.doi.org/10.37201/req/136.2021
Rev Esp Quimioter 2022; 35(2):225-226 [Texto completo PDF]
DAVID SÁNCHEZ FABRA, ELENA ABAD VILLAMOR, SUSANA CLEMOS MATAMOROS, JUAN VALLE PUEY, MARÍA JESÚS IGÚZQUIZA PELLEJERO, ÁNGEL LUIS GARCÍA FORCADA
Published: 4 February 2022
LETTER TO THE EDITOR
http://www.doi.org/10.37201/req/147.2021
Rev Esp Quimioter 2022; 35(2):229-230 [Full-text PDF]
CARL LLOR, ANA MORAGAS, JOSEP M. COTS
Published: 3 February 2022
http://www.doi.org/10.37201/req/141.2021
Objectives. We aimed to compare the actual consumption of antibiotics among patients issued delayed antibiotic prescribing with the consumption observed in a non-systematic review of studies on delayed prescribing.
Methods. Observational study carried out in three primary care centres from September 2018 until March 2020. We tracked the electronic records of the 82 patients with episodes of acute bronchitis and 44 acute pharyngitis who were given a patient-led delayed prescription to determine whether the prescription was filled and when this medication was obtained.
Results. The prescriptions were never filled in 50 cases (39.7%), but five patients took another antibiotic within the first two weeks. Out of 76 patients who did take the delayed prescription, only 12 obtained the medication based on the instructions given by the doctors (15.8%).
Conclusions. The strategy of delayed antibiotic prescribing resulted in a reduction in antibiotic use, but this reduction was lower than in randomised clinical trials, being comparable to the results obtained with other observational studies on delayed antibiotic prescribing. In addition, only a few patients adhered to the doctors’ instructions.
Rev Esp Quimioter 2022; 35(2):213-217 [Full-text PDF] [Supplementary material PDF]
DAVID SÁNCHEZ FABRA, ELENA ABAD VILLAMOR, SUSANA CLEMOS MATAMOROS, JUAN VALLE PUEY, MARÍA JESÚS IGÚZQUIZA PELLEJERO, ÁNGEL LUIS GARCÍA FORCADA
Published: 2 February 2022
CLINICAL-PATHOLOGIC CONFERENCE
http://www.doi.org/10.37201/req/138.2021
Rev Esp Quimioter 2022; 35(2):218-221 [Full-text PDF]
FERRÁN LLOPIS-ROCA, RAÚL LÓPEZ IZQUIERDO, OSCAR MIRO, JORGE ERIC GARCÍA-LAMBERECHTS, AGUSTÍN JULIÁN JIMÉNEZ, JUAN GONZÁLEZ DEL CASTILLO
Published: 1 February 2022
http://www.doi.org/10.37201/req/150.2021
Objective. To describe the approach to the patients with suspected sepsis in the Spanish emergency department hospitals (ED) and analyze whether there are differences according to the size of the hospital and the number of visits to the emergency room.
Method. Structured survey of those responsible for the 282 public EDs that serve adults 24 hours a day, 365 days a year. It was asked about assistance and management in the emergency room in the care of patients with suspected sepsis. The results are compared according to hospital size (large ≥ 500 beds vs medium-small <500) and influx to the emergency room (discharge ≥ 200 visits / day vs medium-low <200).
Results. A total of 250 Spanish EDs responded (89%). Sepsis protocols are available in 163 (65%) EDs median weekly sepsis treated ranged from 0-5 per week in 39 (71%) ED, 6-10 per week in 10 (18%), 11-15 per week in 4 (7%), and more than 15 activations per week in 3 centers (3.6%). The criteria used for sepsis diagnosis were the qSOFA/SOFA in 105 (63.6%) of the hospitals, SIRS in 6 (3.6%), while in 49 (29.7%) they used both criteria simultaneously. In 79 centers, the sepsis diagnosis was computerized, and in 56 there were tools to help decision-making. 48% (79 of 163) of the EDs had data on bundles compliance. In 61% (99 of 163) of EDs there was training in sepsis and in 56% (55 of 99) it was periodic. Considering the size of the hospital, large hospitals participated more frequently as recipients of patients with sepsis and had an infectious, sepsis and short-stay unit, a microbiologist and infectious disease specialist on duty.
Conclusion. Most EDs have sepsis protocols, but there is room for improvement. The computerization and development of alerts for diagnosis and treatment still have a long way to go in EDs.
Rev Esp Quimioter 2022; 35(2):192-203 [Texto completo PDF] [Supplementary material PDF]
AZUCENA BAUTISTA HERNÁNDEZ, ENRIQUE DE VEGA-RÍOS, JORGE SERRANO BALLESTEROS, DANIEL USEROS BRAÑA, LAURA CARDEÑOSO DOMINGO, ANGELS FIGUEROLA TEJERINA, ANDRÉS VON WERNITZ TELEKI, DAVID JIMÉNEZ JIMÉNEZ, IGNACIO DE LOS SANTOS GIL, CARMEN SÁEZ BÉJAR
Published: 31 January 2022
http://www.doi.org/10.37201/req/132.2021
Introduction. Sepsis is the main cause of death in hospitals and the implementation of diagnosis and treatment bundles has shown to improve its evolution. However, there is a lack of evidence about patients attended in conventional units.
Methods. A 3-year retrospective cohort study was conducted. Patients hospitalized in Internal Medicine units with
sepsis were included and assigned to two cohorts according to Sepsis Code (SC) activation (group A) or not (B). Baseline and evolution variables were collected.
Results. A total of 653 patients were included. In 296 cases SC was activated. Mean age was 81.43 years, median Charlson comorbidity index (CCI) was 2 and 63.25% showed some functional disability. More bundles were completed in group A: blood cultures 95.2% vs 72.5% (p < 0.001), extended spectrum antibiotics 59.1% vs 41.4% (p < 0.001), fluid resuscitation 96.62% vs 80.95% (p < 0.001). Infection control at 72 hours was quite higher in group A (81.42% vs 55.18%, odds ratio 3.55 [2.48-5.09]). Antibiotic was optimized more frequently in group A (60.77% vs 47.03%, p 0.008). Mean in-hospital stay was 10.63 days (11.44 vs 8.53 days, p < 0.001). Complications during hospitalization appeared in 51.76% of patients, especially in group B (45.95% vs 56.58%, odds ratio 1.53 [1.12-2.09]). Hospital readmissions were higher in group A (40% vs 24.76%, p < 0.001). 28-day mortality was significantly lower in group A (20.95% vs 42.86%, odds ratio 0.33 [0.23-0.47]).
Conclusions. Implementation of SC seems to be effective in improving short-term outcomes in IM patients, although therapy should be tailored in an individual basis.
Rev Esp Quimioter 2022; 35(2):178-191 [Full-text PDF]
LOURDES VIDAL OLIVER, PATRICIA BAYO CALDUCH, LORENA FORQUÉ RODRÍGUEZ, DAVID NAVARRO ORTEGA, ANTONIO MIGUEL DUCH SAMPER, JAVIER COLOMINA RODRÍGUEZ
Published: 24 January 2022
http://www.doi.org/10.37201/req/128.2021
Introduction. Staphylococcus epidermidis (SE) is a common cause of bacterial keratitis in certain geographic areas. A high percentage of resistance to methicillin is shown, which gives it cross resistance to beta-lactams and sometimes resistance to other antibacterial groups. We analyzed clinical and microbiological variables in patients with infectious keratitis due to SE.
Methods. Medical records of 43 patients with suspected infectious keratitis and microbiological confirmation for SE, between October 2017 and October 2020, were retrospectively studied. Clinical characteristics (risk factors, size of lesions, treatment, evolution) and microbiological (susceptibility to antibiotics) were analyzed, and groups of patients with methicillin-resistant (MRSE) and methicillin-susceptible (MSSE) infection were compared.
Results. MRSE was present in 37.2% of infectious keratitis. All isolates were sensitive to vancomycin and linezolid. Rates of resistance to tetracyclines and ciprofloxacin were 50% and 56% in the MRSE group, and 11% and 7% in the MSSE group. The clinical characteristics, including size of lesion, visual axis involvement, inflammation of anterior chamber, presence of risk factors and follow-up time, did not show statistically significant differences between groups.
Conclusions. MRSE is a common cause of infectious keratitis caused by SE and shows a high rate of multidrug resistance. Clinically, it does not differ from MSSE keratitis. Additional work is needed to confirm these findings.
Rev Esp Quimioter 2022; 35(2):171-177 [Full-text PDF]
RAFAEL CANTÓN, JOSÉ BARBERÁN, MANUEL LINARES, JOSÉ MARÍA MOLERO, JOSÉ MIGUEL RODRÍGUEZ-GONZÁLEZ-MORO, MIGUEL SALAVERT, JUAN GONZÁLEZ DEL CASTILLO
Published: 19 January 2022
http://www.doi.org/10.37201/req/172.2021
Lower respiratory tract infections, including chronic obstructive pulmonary disease exacerbations (COPD-E) and community acquired pneumonia (CAP), are one of the most frequent reasons for consultation in primary care and hospital emergency departments, and are the cause of a high prescription of antimicrobial agents. The selection of the most appropriate oral antibiotic treatment is based on different aspects and includes to first consider a bacterial aetiology and not a viral infection, to know the bacterial pathogen that most frequently cause these infections and the frequency of their local antimicrobial resistance. Treatment should also be prescribed quickly and antibiotics should be selected among those with a quicker mode of action, achieving the greatest effect in the shortest time and with the fewest adverse effects (toxicity, interactions, resistance and/or ecological impact). Whenever possible, antimicrobials should be rotated and diversified and switched to the oral route as soon as possible. With these premises, the oral treatment guidelines for mild or moderate COPD-E and CAP in Spain include as first options beta-lactam antibiotics (amoxicillin and amoxicillin-clavulanate and cefditoren), in certain situations associated with a macrolide, and relegating fluoroquinolones as an alternative, except in cases where the presence of Pseudomonas aeruginosa is suspected.
Rev Esp Quimioter 2022; 35(1):16-29 [Full-text PDF] [Texto completo – PDF]
LEONARDO LORENTE, MARÍA LECUONA, ALEJANDRA PÉREZ-LLOMBET, ADRIANA GONZÁLEZ-MESA, MANUEL CALLEJÓN, TERESA DELGADO MELIAN, INÉS OLAYA GARCIA, ALEJANDRO JIMÉNEZ, MARÍA LUISA MORA, ANA MADUEÑO
Published: 17 January 2022
http://www.doi.org/10.37201/req/110.2021
Objective. The aim of our study was to analyze sonication and Maki techniques for diagnosis of catheter tip colonization and catheter-related bloodstream infection (CRBSI) on patients admitted to ICU.
Material and methods. Observational and prospective study in one Intensive Care Unit. Patients with some central venous catheter (CVC) at least for 7 days and catheter-related infection (CRI) suspicion (new episode of fever or sepsis) were included. We performed Maki technique followed by sonication of catheter tip. We compared area under the curve (AUC) of Maki, sonication, and techniques combination to diagnosis catheter tip colonization and CRBSI.
Results. We included 94 CVC from 87 CRI suspicion episodes. We found 14 cases of catheter tip colonization and 10 cases of CRBSI. Of the 14 catheter tip colonization cases, 7 (50.0%) were detected by Maki and sonication techniques, 6 (42.9%) were detected only by Maki technique, and 1 (7.1%) was detected only by sonication technique. Of the 10 CRBSI, 6 (60.0%) were detected by Maki and sonication techniques, 4 (40.0%) were detected only by Maki technique, and any only by sonication technique. We found higher AUC in Maki technique than in sonication technique to diagnosis of CRBSI (p=0.02) and to diagnosis of catheter tip colonization (p=0.03). No significant differences were found in AUC between Maki technique and combination techniques for diagnosis of catheter tip colonization (p=0.32) and of CRBSI (p=0.32).
Conclusion. Sonication did not provide reliability to Maki technique for diagnosis of catheter tip colonization and CRBSI.
Rev Esp Quimioter 2022; 35(2):165-170 [Full-text PDF]
