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Rev Esp Quimioter 2022; 35(5):482-491

Congenital cytomegalovirus infection, is more prevalent in our country in newborns exposed to HIV?

JORGE BUSTAMANTE-AMADOR, ISABEL MELLADO-SOLA, MARÍA PILAR ROMERO-GÓMEZ, MARTA CABRERA-LAFUENTE, MARÍA DE LA CALLE-FERNÁNDEZ-MIRANDA, TALÍA SAINZ-COSTA, MARÍA JOSÉ MELLADO-PEÑA, LUIS ESCOSA-GARCÍA, EN REPRESENTACIÓN DEL GRUPO DE TRABAJO SOBRE INFECCIÓN PERINATAL-NEONATOLOGÍA-GINECOLOGÍA (GINPER)

Published: 18 July 2022

http://www.doi.org/10.37201/req/037.2022

Objectives. Congenital cytomegalovirus infection (cCMV) has been considered more prevalent among HIV-exposed children during pregnancy. Spanish national guidelines recommend the cCMV screening in these newborns. Nowadays, pregnant women have a better control of HIV infection compared to previous decades. We aim to analyze the prevalence and associated risk factors to cCMV in these children.
Patients and methods. A retrospective cross-sectorial study was performed. All newborns exposed to HIV were assisted in a third-level hospital (2014-2020). Epidemiological and clinical data of the mother and newborn were recorded. Shell vial urine culture and/or CRP were performed along the two first weeks of life for the neonatal screening of cCMV.
Results. Overall 69 newborns were enrolled. A high proportion (82.4%) of the mothers had been diagnosed with HIV before getting pregnant. All women received ART during the pregnancy. Median T-CD4 lymphocytes before delivery was 641/mm3 (IQR: 480-865) and the viral load was undetectable in 83.6%. Serological test for CMV along the first trimester of pregnancy was performed in 73.5% (positive IgG in 96%). There were no congenital cases of HIV neither cCMV (CI 95%:0-5.3%).
Conclusions. The cCMV prevalence in newborns exposed to HIV was 0%, lower than reported before, probably related to a better and earlier ART during pregnancy, leading to a better immunological status.

Rev Esp Quimioter 2022; 35(5):482-491 [Texto completo PDF]


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Rev Esp Quimioter 2022; 35(4):357-361

Interactions listed in the Paxlovid fact sheet, classified according to risks, pharmacological groups, and consequences

JOSÉ RAMÓN AZANZA, JOSEP MENSA, JUAN GONZÁLEZ DEL CASTILLO, MANUEL LINARES RUFO, JOSÉ MARÍA MOLERO, NATALIA MADERO VALLE, JOSÉ BARBERÁN

Published: 13 July 2022

http://www.doi.org/10.37201/req/054.2022

Paxlovid (nirmatrelvir plus ritonavir) is a new oral antiviral therapeutic for the treatment of COVID-19. Nirmatrelvir is an inhibitor of SARS-CoV-2 main protease, while ritonavir is used as a CYP3A inhibitor in low doses to slow the metabolism of nirmatrelvir, thus enhancing their therapeutic effect. The isoenzyme CYP3A4 is responsible for at least part of the oxidative metabolism of approximately 60% of available medications and ritonavir is therefore a significant source of drug interactions. We describe here the drugs that are contraindicated or should be used with or without precautions when Paxlovid (nirmaltrevir plus ritonavir) should be administered according to each fact sheet in force at the Spanish Agency for Medicines and Health Products.

Rev Esp Quimioter 2022; 35(4):357-361 [Full-text PDF]


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Rev Esp Quimioter 2022; 35(5):503-505

Two rare cases of pleural infection due to Prevotella species  

FERNANDO COBO, ANA LARA-OYA, IGNACIO CORREA, ENRIQUE RODRÍGUEZ-GUERRERO, VIRGINIA PÉREZ-CARRASCO, JOSÉ A. GARCÍA-SALCEDO, JOSÉ MARÍA NAVARRO-MARÍ

Published: 14 July 2022

LETTER TO THE EDITOR

http://www.doi.org/10.37201/req/046.2022

Rev Esp Quimioter 2022; 35(5):503-505  [Full-text PDF]


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Rev Esp Quimioter 2022; 35(5):492-497

The postal code as a “bar code” of antimicrobial resistance

PILAR GALICIA, MANUEL LINARES, ÁNGEL MIGUEL-BENITO, FELIPE PÉREZ GARCÍA, MIGUEL GÓRGOLAS, JOSÉ-MANUEL RAMOS-RINCÓN, JUAN CUADROS

Published: 13 July 2022

http://www.doi.org/10.37201/req/021.2022

Introduction. The need to integrate local resistances into clinical practice is increasingly urgent, especially in Primary Care where empirical treatment is frequent.
Methods. A retrospective observational study of positive microbiological isolates of Neisseria gonorrhoeae from any location (urethral, cervical, pharyngeal, rectal or urine) was carried out in the health area of Alcalá de Henares. Sociodemographic characteristics and resistance to cephalosporins, azithromycin, penicillin and quinolones were analyzed. Each isolate was related to its postal code of origin.
Results. We analyzed 256 microbiological samples of N.gonorrhoeae, most of them male (92.9%) with a mean age of 33 years. Half of the samples (49.8%) were resistant to ciprofloxacin. Temporal and spatial evolution of antimicrobial resistance was integrated in heat maps.
Conclusion. Knowing local resistances can help to prescribe more adequate empirical treatments, especially in Primary Care, avoiding inadequate antibiotics and decreasing resistance rates.

Rev Esp Quimioter 2022; 35(5):492-497 [Texto completo PDF]


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Rev Esp Quimioter 2022; 35(4):415-417

Herpes zoster complicated with aseptic meningitis after cardiac transplantation: Report of two cases and review of the literature  

MARTA GARCIA-MONTERO, CARLOS ORTIZ-BAUTISTA, MARICELA VALERIO, MARÍA OLMEDO, PATRICIA MUÑOZ, EDUARDO ZATARAIN NICOLÁS, CLARA FERNANDEZ-CORDON, FRANCISCO FERNÁNDEZ-AVILÉS

Published: 12 July 2022

LETTER TO THE EDITOR

http://www.doi.org/10.37201/req/033.2022

Rev Esp Quimioter 2022; 35(4):415-417  [Full-text PDF]


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Rev Esp Quimioter 2022; 35(5):475-481

Clindamycin but not Intravenous Immunoglobulins reduces mortality in a retrospective cohort of critically ill patients with bacteremic Group A Streptococcal infections

ADELA FERNÁNDEZ-GALILEA, ÁNGEL ESTELLA, JOSÉ LUIS GARCÍA-GARMENDIA, ANA LOZA, INMACULADA PALACIOS-GARCÍA, RAFAEL SIERRA-CAMERINO, GEMMA SELLER, MARINA RODRÍGUEZ-DELGADO, ISABEL RODRIGUEZ-HIGUERAS, JOSÉ GARNACHO-MONTERO

Published: 7 July 2022

http://www.doi.org/10.37201/req/030.2022

Objectives. Mortality of patients requiring Intensive Care Unit (ICU) admission for an invasive group A streptococcal (GAS) infection continues being high. In critically ill patients with bacteremic GAS infection we aimed at determining risk factors for mortality.
Patients and methods. Retrospective multicentre study carried out in nine ICU in Southern Spain. All adult patients admitted to the participant ICUs from January 2014 to June 2019 with one positive blood culture for S. pyogenes were included in this study. Patient characteristics, infection-related variables, therapeutic interventions, failure of organs, and outcomes were registered. Risk factors independently associated with ICU and in-hospital mortalities were determined by multivariate regression analyses.
Results. Fifty-seven patients were included: median age was 63 (45-73) years, median SOFA score at admission was 11 (7-13). The most frequent source was skin and soft tissue infection (n=32) followed by unknown origin of bacteremia (n=12). In the multivariate analysis, age (OR 1.079; 95% CI 1.016-1.145), SOFA score (OR 2.129; 95% CI 1.339-3.383) were the risk factors for ICU mortality and the use of clindamycin was identified as a protective factor (OR 0.049; 95% CI 0.003-0.737). Age and SOFA were the independent factors associated with hospital mortality however the use of clindamycin showed
a strong trend but without reaching statistical significance (OR 0.085; 95% CI 0.007-1.095).
Conclusion. In this cohort of critically ill patients the use of intravenous immunoglobulin was not identified as a protective factor for ICU or hospital mortality treatment with clindamycin significantly reduced mortality after controlling for confounders.

Rev Esp Quimioter 2022; 35(5):475-481 [Full-text PDF]


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Rev Esp Quimioter 2022; 35(6):509-518

Monkeypox in humans: a new outbreak

MARI CRUZ MARTÍN-DELGADO, FRANCISCO JAVIER MARTÍN-SÁNCHEZ, MANUEL MARTÍNEZ-SELLÉS, JOSÉ MARÍA MOLERO GARCÍA, SANTIAGO MORENO GUILLÉN, FERNANDO RODRÍGUEZ-ARTALEJO, JULIÁN RUIZ-GALIANA, RAFAEL CANTÓN, PILAR DE LUCAS RAMOS, ALEJANDRA GARCÍA-BOTELLA, ALBERTO GARCÍA-LLEDÓ, TERESA HERNÁNDEZ-SAMPELAYO, JAVIER GÓMEZ-PAVÓN, JUAN GONZÁLEZ DEL CASTILLO, PATRICIA MUÑOZ, MARICELA VALERIO, PILAR CATALÁN, ALMUDENA BURILLO, ALEJANDRO COBO, ANTONIO ALCAMÍ, EMILIO BOUZA

Published: 6 July 2022

http://www.doi.org/10.37201/req/059.2022

Infection caused by Monkeypox Virus (MPVX) has small rodents as its natural reservoir and both monkeys and humans are occasional hosts. The causative agent is an Orthopoxvirus (MPVX) that was isolated in monkeys in 1958 and proved capable of passing to humans in 1970. It remained contained in Africa, causing isolated episodes of infection, until 2003 when an outbreak occurred in the United States following importation of animals from that continent. Since then, anecdotal cases have continued to be reported outside Africa, usually very clearly linked to travelers to those countries, but in May 2022, a broad outbreak of this disease has begun, now affecting several continents, with the emergence of human cases of MPVX (H-MPVX) infection mainly among Men that have Sex with Men (MSM). The disease has an incubation time ranging from 5 to 15 days and is characterized by the presence of pustules, fever, malaise and headache. The presence of significant regional lymphadenopathy is a differential feature with episodes of classical smallpox. Proctitis and pharyngitis, with minimal skin lesions, may be another form of presentation. Diagnosis can be confirmed by PCR testing of lesions or by demonstration of MPVX in other body fluids or tissues, although in the appropriate epidemiologic setting the clinical picture is highly suggestive of the disease. Effective drug treatment has been developed as part of programs to protect against potential bioterrorist agents and smallpox vaccinees are known to have high protection against monkeypox. New vaccines are available, but neither the drugs nor the vaccines are yet freely available on the market. The prognosis of the disease appears, at least in adults in developed countries, to be good, with very low mortality figures and much less aggressive behavior than that described in classical smallpox. Isolation measures, essential for the control of the outbreak, have been published by the health authorities.

Rev Esp Quimioter 2022; 35(6):509-518 [Full-text PDF]


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Rev Esp Quimioter 2022; 35(5):444-454

Lessons from COVID-19 for future disasters: an opinion paper

JUAN GONZÁLEZ DEL CASTILLO, MARI CRUZ MARTÍN-DELGADO, FRANCISCO JAVIER MARTÍN-SÁNCHEZ, MANUEL MARTÍNEZ-SELLÉS, JOSÉ MARÍA MOLERO GARCÍA, SANTIAGO MORENO GUILLÉN, FERNANDO RODRÍGUEZ-ARTALEJO, JULIÁN RUIZ-GALIANA, RAFAEL CANTÓN, PILAR DE LUCAS RAMOS, ALEJANDRA GARCÍA-BOTELLA, ALBERTO GARCÍA-LLEDÓ, TERESA HERNÁNDEZ-SAMPELAYO, JAVIER GÓMEZ-PAVÓN, EMILIO BOUZA

Published: 27 June 2022

http://www.doi.org/10.37201/req/058.2022

A “Pandemic/Disaster Law” is needed to condense and organize the current dispersed and multiple legislation. The State must exercise a single power and command appropriate to each situation, with national validity. The production of plans for the use of land and real estate as potential centers for health care, shelter or refuge is recommended. There should be specific disaster plans at least for Primary Health Care, Hospitals and Socio-sanitary Centers. The guarantee of the maintenance of communication and supply routes is essential, as well as the guarantee of the autochthonous production of basic goods. The pandemic has highlighted the need to redefine the training plans for physicians who, in their different specialties, have to undertake reforms that allow a more versatile and transversal training. National research must have plans to be able to respond quickly to questions posed by the various crises, using all the nation’s resources and in particular, all the data and capabilities of the health sector. Contingency plans must consider ethical aspects, and meet the needs of patients and families with a humanized approach. In circumstances of catastrophe, conflicts increase and require a bioethical response that allows the best decisions to be made, with the utmost respect for people’s values. Rapid, efficient and truthful communication systems must be contained in a special project for this sector in critic circumstances. Finally, we believe that the creation of National Coordination Centers for major disasters and Public Health can contribute to better face the crises of the future.

Rev Esp Quimioter 2022; 35(5):444-454 [Full-text PDF]


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Rev Esp Quimioter 2022; 35(5):435-443

Expert opinion on strategies to improve vaccination coverage against seasonal influenza

CARMEN VELICIA PEÑAS, VÍCTOR MIGUEL DEL CAMPO PÉREZ, IRENE RIVERO CALLE, LORENZO ARMENTEROS DEL OLMO, MARÍA TERESA PÉREZ RODRÍGUEZ, JUAN JESÚS GESTAL OTERO

Published: 21 June 2022

http://www.doi.org/10.37201/req/031.2022

Seasonal flu continues to be a major public health concern, and the influenza vaccine remains the most effective preventive measure. In Spain, vaccination coverage data from previous seasons show vaccination rates well below official targets; however, these figures improved significantly after the COVID-19 pandemic. Given the importance of achieving and maintaining high vaccination rates in order to avoid the clinical and economic impact of influenza, our multidisciplinary group of experts on vaccines analyzed the impact of low vaccination rates in Spain and drafted a series of measures to boost influenza vaccination coverage, particularly among priority groups.

Rev Esp Quimioter 2022; 35(5):435-443 [Texto completo PDF]


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Rev Esp Quimioter 2022; 35(4):401-405

Comparison between five PCR techniques for the diagnosis of SARS-CoV-2

ALBERTO TENORIO-ABREU, ANA RUIZ-CASTILLO, ANTONIO FRANCISCO GUZMÁN-GONZÁLEZ, ALEJANDRO PEÑA-MONJE, JOSÉ MARÍA SAAVEDRA-MARTÍN, FRANCISCO FRANCO-ÁLVAREZ DE LUNAO

Published: 20 June 2022

http://www.doi.org/10.37201/req/076.2020

Introduction. Since the first cases of SARS-CoV-2 appeared, there have been numerous techniques that have been developed for the diagnosis or monitoring of infection, both direct and serological techniques. Choosing a good diagnostic tool is essential for epidemiological control. The objective was to compare five commercialized RT-PCR techniques in real time, in sensitivity, specificity and agreement for the detection of SARS-CoV-2.
Material and methods. Five commercial RT-PCR kits for the detection of SARS-CoV-2 were compared. Eight known positive samples were taken and subjected to seven different dilutions or concentrations, and another 135 negative samples were used to determine sensitivity, specificity, and agreement values.
Results. The sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) for the Palex, Roche and GeneXpert techniques with respect to Seegene were identical, corresponding to 98.21%, 100%, 100% and 99.26% respectively. For Becton Dickinson the sensitivity was 89.28%, the specificity of 100%, the PPV of 100% and the NPV of 95.74%. The agreement using the Kappa index for Palex, Roche and GeneXpert was 0.9892, while the agreement for Becton Dickinson was with a Kappa index of 0.9215.
Conclusion. All commercial RT-PCR kits had high sensitivities and specificities, as well as PPV, NPV, and concordance.

Rev Esp Quimioter 2022; 35(4):401-405 [Texto completo PDF]


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