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Rev Esp Quimioter 2022;35(Suppl.1):40-42

Ceftazidime-avibactam

FRANCISCO SANZ HERRERO

Published: 22 April 2022

http://www.doi.org/10.37201/req/s01.09.2022

The increase in nosocomial infections by beta-lactamase producing Gram-negative bacilli constitutes a therapeutic challenge. The combination of ceftazidime-avibactam offers a very interesting therapeutic option for nosocomial pneumonia caused by extended-spectrum beta-lactamase-producing Klebsiella pneumoniae, multidrug-resistant Pseudomonas aeruginosa, and other enterobacteria. Compared to carbapenems, ceftazidime-avibactam has demonstrated non-inferiority in the treatment of nosocomial pneumonia including better clinical and microbiological cure rates and mortality compared to colistin. The limitation of ceftazidime-avibactam in the treatment of infections caused by metallo-beta-lactamase-producing Enterobacteriaceae can be overcome with the addition of aztreonam.

Rev Esp Quimioter 2022; 35(Suppl. 1):40-42 [Full-text PDF]


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Rev Esp Quimioter 2022;35(Suppl.1):35-39

Ceftolozane-tazobactam in nosocomial pneumonia

FRANCISCO JAVIER CANDEL, JUAN GONZÁLEZ DEL CASTILLO, AGUSTÍN JULIÁN JIMÉNEZ, MAYRA MATESANZ

Published: 22 April 2022

http://www.doi.org/10.37201/req/s01.08.2022

Ceftolozane is a potent antimicrobial against Pseudomonas aeruginosa, including carbapenem-resistant and multidrug-resistant strains, and is also active against Enterobacteriaceae. It MIC (minimal inhibitory concentration) and MPC (mutant preventive concentration) are close together, allowing to avoid the mutant selection window specifically in the treatment of Pseudomonas aeruginosa infection. The molecule is time-dependent and stable when reconstituted at room temperature, facilitating safe and effective dosage optimization in frail and critically ill patients. It has been shown to be non-inferior to meropenem in the treatment of nosocomial infection in the ASPECT-NP study but superior in post-hoc studies in the subgroup of patients with ventilator-associated pneumonia, without the emergence of resistance during treatment. It is FDA approved at a dose of 3 g every 8 hours in the treatment of nosocomial pneumonia (HABP/VABP) in adults.

Rev Esp Quimioter 2022; 35(Suppl. 1):35-39 [Full-text PDF]


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Rev Esp Quimioter 2022;35(Suppl.1):31-34

Cefiderocol

MARÍA CRUZ SORIANO, JESSIE MONTUFAR, AARON BLANDINO-ORTIZ

Published: 22 April 2022

http://www.doi.org/10.37201/req/s01.07.2022

Cefiderocol is a new siderophore cephalosporin with potent in vitro activity against gram-negative bacilli including Enterobacterales that produce all kinds of carbapenemases and non-fermenting Gram-negative with difficult-to-treat resistance. As a β-lactam, its efficacy is optimized in extended-perfusion and requires dose adjustment in renal dysfunction and hyperclearance. Its efficacy has been validated in three clinical trials, one of them in the treatment of hospital-acquired pneumonia and ventilator-associated pneumonia. The clinical trial aimed at difficult-to-treat gram-negatives achieved the clinical and microbiological target, but the increase in mortality observed in the cefiderocol arm makes it necessary to demonstrate efficacy in real clinical practice. Cefiderocol is a good option among the new β-lactams for the treatment of pneumonia caused by Gram-negative bacilli carbapenem-resistant.

Rev Esp Quimioter 2022; 35(Suppl. 1):31-34 [Full-text PDF]


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Rev Esp Quimioter 2022;35(Suppl.1):28-30

Ceftaroline in severe community-acquired pneumonia

CATIA CILLONIZ, JUAN M PERICÀS, JORGE ROJAS

Published: 22 April 2022

http://www.doi.org/10.37201/req/s01.06.2022

Severe community-acquired pneumonia (SCAP) is associated with high mortality. Factor such as early adequate antibiotic therapy, delay in intensive care unit (ICU) care and pneumonia caused by resistant pathogens are associated with worse outcomes in SCAP patients. Ceftaroline is a fifth-generation cephalosporin with bactericidal activity against Gram-positive pathogens (including methicillin-resistant Staphylococcus aureus [MRSA] and multidrug-resistant Streptococcus pneumoniae) and common Gram-negative organisms. The efficacy and safety for the treatment of pneumonia was evaluated in three randomized control trials were ceftaroline demonstrated superiority against ceftriaxone for the treatment of pneumonia in hospitalized patients with Pneumonia Severity Index (PSI) III – IV.

Rev Esp Quimioter 2022; 35(Suppl. 1):28-30 [Full-text PDF]


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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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