Reduction in the risk of progression of solid organ transplant recipients infected by SARS-CoV-2 treated with monoclonal antibodies

FRANCISCO JAVIER CANDEL, MIGUEL SALAVERT, DAVID LORITE MINGOT, MARTA MANZANO CRESPO, PAULA PÉREZ PORTERO, RAFAEL CUERVO PINTO

Published: 24 April 2023

http://www.doi.org/10.37201/req/023.2023

Recipients of solid organ transplants (SOT) are at higher risk of infection by SARS-CoV-2 virus especially due to chronic immunosuppression therapy and frequent multiple comorbid conditions. COVID-19 is a potentially life-threatening disease in SOT recipients, with an increased likelihood of progressing to severe disease, with the need of hospitalization, admission to the intensive care unit (ICU) and mechanical ventilatory support. This article presents an updated review of different aspects related to the outcome of COVID-19 in SOT recipients. In nvaccinated SOT recipients, COVID-19 is associated with a high mortality rate, in-patient care and ICU admission, and impaired graft function or rejection in severe disease. In vaccinated SOT recipients even after full vaccination, there is a reduction of the risk of mortality, but the course of COVID-19 may continue to be severe, influenced by the time from transplant, the net state of immunosuppression and having suffered graft rejection or dysfunction. SOT recipients develop lower immunity from mRNA vaccines with suboptimal response. Treatment with mAbs provides favorable outcomes in non-hospitalized SOT recipients at high risk for severe disease, with lower rates of hospitalization, emergency department visits, ICU care, progression to severe disease, and death. However, broad vaccination and therapeutic options are required, particularly in light of the tendency of the SARS-CoV-2 virus to adapt and evade both natural and vaccine-induced immunity.

Rev Esp Quimioter 2023; 36(4): 380-391 [Full-text PDF]

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Efficacy, effectiveness and safety of the adjuvanted influenza vaccine in the population aged 65 or over

MARÍA PILAR ARRAZOLA MARTÍNEZ, JOSÉ MARÍA EIROS BOUZA, PERE PLANS RUBIÓ, JOAN PUIG-BARBERÀ, JESÚS RUIZ ARAGÓN, ÁLVARO TORRES LANA

Published: 20 April 2023

http://www.doi.org/10.37201/req/145.2022

Most of the complications and deaths related to seasonal flu occur in the elderly population (≥65 years) with comorbidities, and the influenza vaccine is the most effective way to prevent them. Immunization is less effective in older adults due to immunosenescence. MF59-adjuvanted vaccines, designed to improve the magnitude, persistence and amplitude of the immune response in elderly people, have been used in clinical practice since 1997 in their trivalent formulation and, since 2020, in their tetravalent formulation. Data from various studies show that these vaccines are not only safe for all age groups, with a reactogenicity profile similar to that of the conventional vaccine, but also that they are especially effective in boosting the immune response in the population aged 65 or over by increasing antibody titers after vaccination and significantly reducing the risk of hospital admission. Adjuvanted vaccines have been shown to provide cross-protection against heterologous strains and to be as effective as the high-dose vaccine in the population aged 65 or over. In this review, the scientific evidence on the efficacy and effectiveness of the MF59-adjuvanted vaccine in real clinical practice in people ≥65 years of age is analyzed through a narrative and descriptive review of the literature with data from clinical trials, observational studies and systematic reviews or meta-analysis.

Rev Esp Quimioter 2023; 36(4): 334-345 [Texto completo – PDF]

Recommendations on the use of azole antifungals in hematology-oncology patients

JOSÉ RAMÓN AZANZA, JOSÉ MENSA, JOSÉ BARBERÁN, LOURDES VÁZQUEZ, JAIME PÉREZ DE OTEYZA, MI KWON, LUCRECIA YÁÑEZ, JOSÉ MARÍA AGUADO, ANTONIO CUBILLO GRACIAN, CARLOS SOLANO, ISABEL RUIZ CAMPS, JESÚS FORTÚN, MIGUEL SALAVERT LLETÍ, CARLOTA GUDIOL, TERESA OLAVE RUBIO, CAROLINA GARCÍA-VIDAL, MONTSERRAT ROVIRA TARRATS, MARÍA SUÁREZ-LLEDÓ GRANDE, PEDRO GONZÁLEZ-SIERRA, CARLOS DUEÑAS GUTIÉRREZ

Published: 5 April 2023

http://www.doi.org/10.37201/req/013.2023

The administration of antifungals for therapeutic and, especially, prophylactic purposes is virtually a constant in patients requiring hematology-oncology treatment. Any attempt to prevent or treat Aspergillus or Mucor infections requires the administration of some drugs in the azole group, which include voriconazole, posaconazole and isavuconazole, noted for their activity against these pathogens. One very relevant aspect is the potential risk of interaction when associated with one of the antineoplastic drugs used to treat hematologic tumors, with serious complications. In this regard, acalabrutinib, bortezomib, bosutinib, carfilzomib, cyclophosphamide, cyclosporine A, dasatinib, duvelisib, gilteritinib, glasdegib, ibrutinib, imatinib, nilotinib, ponatinib, prednisone, ruxolitinib, tacrolimus, all-transretinoic acid, arsenic trioxide, venetoclax, or any of the vinca alkaloids, are very clear examples of risk, in some cases because their clearance is reduced and in others because of increased risk of QTc prolongation, which is particularly evident when the drug of choice is voriconazole or posaconazole.

Rev Esp Quimioter 2023; 36(3): 226-258 [Full-text PDF]

Otomastoiditis tuberculosa: a propósito de un caso   

IRIS SHARON PÉREZ RAMOS, MIREN JOSEBE UNZAGA BARAÑANO, MARÍA CARMEN ESPALLARGAS RUIZ-OGARRIO, JOSÉ LUIS DIAZ DE TUESTA DEL ARCOO

Published: 27 March 2023

LETTER TO THE EDITOR

http://www.doi.org/10.37201/req/139.2022

Rev Esp Quimioter 2023; 36(3): 332-333  [Texto completo PDF]

Activity of imipenem/relebactam against Enterobacterales and Pseudomonas aeruginosa in Spain. SMART 2016-2020

SERGIO GARCÍA-FERNÁNDEZ, JORGE CALVO, EMILIA CERCENADO, ANA ISABEL SUÁREZ-BARRENECHEA, MARÍA FERNÁNDEZ-BILLÓN, FRANCISCO JAVIER CASTILLO, LYDIA GÁLVEZ-BENÍTEZ, FE TUBAU, RUTH ESTHER FIGUEROA CERÓN, ALICIA HERNÁNDEZ-CABEZAS, FERNANDO GONZÁLEZ ROMO, MARÍA CARMEN FARIÑAS, MARÍA GÓMEZ, JAZMÍN DÍAZ-REGAÑÓN, RAFAEL CANTÓN

Published: 22 March 2023

http://www.doi.org/10.37201/req/007.2023

Objectives. To determine susceptibility to the novel β-lactam/β-lactamase inhibitor combination imipenem/relebactam in clinical isolates recovered from intra-abdominal (IAI), urinary (UTI), respiratory (RTI) and bloodstream (BSI) infections in the SMART (Study for Monitoring Antimicrobial Resistance Trends) study in SPAIN during 2016 – 2020.
Methods. Broth microdilution MICs for imipenem/relebactam and comparators were determined by a central laboratory against isolates of Enterobacterales and Pseudomonas aeruginosa. MICs were interpreted using EUCAST-2021 breakpoints.
Results. In total, 5,210 Enterobacterales and 1,418 P. aeruginosa clinical isolates were analyzed. Imipenem/relebactam inhibited 98.8% of Enterobacterales. Distinguishing by source of infection susceptibility was 99.1% in BSI, 99.2% in IAI, 97.9% in RTI, and 99.2% in UTI. Of intensive care unit isolates (ICU) 97.4% were susceptible and of non-ICU isolates 99.2% were susceptible. In Enterobacterales, activity against Class A, Class B and Class D carbapenemases was 96.2%, 15.4% and 73.2%, respectively. In P. aeruginosa, imipenem/relebactam was active in 92.2% of isolates. By source of infection it was 94.8% in BSI, 92.9% in IAI, 91.7% in RTI, and 93.1% in UTI. An 88.7% of ICU isolates and 93.6% of non-ICU isolates were susceptible to imipenem/relebactam. Imipenem/relebactam remained active against P. aeruginosa ceftazidime-resistant (76.3%), cefepime-resistant (73.6%), imipenem-resistant (71.5%) and piperacillin-resistant (78.7%) isolates. Of all multidrug-resistant or difficult-to-treat resistance P. aeruginosa isolates, 75.1% and 46.2%, respectively, were susceptible to imipenem/relebactam.
Conclusions. Imipenem/relebactam showed high rates of susceptibility in Enterobacterales and P. aeruginosa isolates from different sources of infection as well as depending on patients’ location (ICU or non-ICU scenarios).

Rev Esp Quimioter 2023; 36(3): 302-309 [Full-text PDF]