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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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Rev Esp Quimioter 2022; 35(3): 249-259

Efficacy of early use of remdesivir: a systematic review of subgroup analysis

MANUEL DAVID GIL-SIERRA, MARIA DEL PILAR BRICEÑO-CASADO, EMILIO JESÚS ALEGRE-DEL REY, MARINA SÁNCHEZ-HIDALGO

Published: 17 March 2022

http://www.doi.org/10.37201/req/154.2021

Introduction. A possible benefit has been suggested for early treatment of severe coronavirus disease 2019 (COVID-19) with remdesivir. The efficacy of this drug is controversial and could significantly influence the efficiency in healthcare systems. The objective is the methodological interpretation of subgroup analyzes according to starting of remdesivir treatment with respect to symptom onset of COVID-19.
Methods. A search in Pubmed® database was performed. Randomized clinical trials (RCTs) with subgroup analysis regarding early and late use of remdesivir were selected. All endpoints were assessed using two methodologies. First methodology considered statistical interaction, pre-specification, biological plausibility, and consistency of results. Second methodology was a validated tool with preliminary questions to discard subset analysis without relevant minimum conditions, and a checklist with recommendations for applicability.
Results. A total of 54 results were found and five RCTs were selected. According first methodology, consistent heterogeneity was only found in time to clinical improvement and better clinical status score at day 15 for patients with severe COVID-19 and <7 days of symptoms. About second methodology, these results about early use of remdesivir may be applied to clinical practice with caution.
Conclusions. We developed a systematic search and application of an established methodology for interpretation of subgroup analysis about early use of remdesivir. Results in severe COVID-19 suggested that early use of remdesivir provides a greater benefit in <7 days of symptoms for time to clinical improvement and better clinical status score at day 15. Future studies could use 7-day cut-off of symptoms to evaluate remdesivir.

Rev Esp Quimioter 2022; 35(3): 249-259 [Full-text PDF]


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Rev Esp Quimioter 2022; 35(4):333-343

COVID in Pediatric Age: an opinion paper

TERESA HERNÁNDEZ-SAMPELAYO, JAVIER GÓMEZ-PAVÓN, 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, CRISTINA CALVO REY, EMILIO BOUZA

Published: 15 March 2022

http://www.doi.org/10.37201/req/012.2022

The incidence of COVID in pediatrics was underestimated during the first months of the pandemic due to the oligosymptomatic nature of the infection in many children and the scarcity of diagnostic tests applied to this population. It is now accepted that children are infected and transmit the disease in the same way as adults. On the contrary, children have less severe and less lethal COVID, probably due to a lower maturity of the child’s immune system, a lower number of ACE2 receptors and the lower presence of comorbidities in this population group.
The development of a multisystemic inflammatory syndrome after SARS-CoV-2 infection in children, despite its rarity, is a very serious condition that frequently requires intensive care. Other less severe post-COVID manifestations have been described in children but are not yet well defined.
COVID has had and continues to have a significant psychological impact on the children themselves, on their caregivers and on the exacerbation of pre-existing psychiatric conditions. We apply adult therapeutic principles to children but with very low levels of evidence. Information on the tolerability of the available medications in this population group is still scarce. The mortality of COVID in children is very low and generally affects children with significant comorbidities.
There are, at present, three vaccines licensed for pediatric use which are compatible with all other vaccines applicable to children.
In these circumstances, there has been much speculation about the indication for vaccination in the pediatric age group, but given its good tolerance, there are clinical and ethical reasons that, in our opinion, justify it.

Rev Esp Quimioter 2022; 35(4):333-343 [Full-text PDF]


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Rev Esp Quimioter 2022; 35(4):307-332

Air pollution and health prevention: A document of reflection

EMILIO BOUZA, FRANCISCO VARGAS, BERNARDINO ALCÁZAR, TERESA ÁLVAREZ, ÁNGEL ASENSIO, GLORIA CRUCETA, DIEGO GRACIA, JESÚS GUINEA, MIGUEL ANGEL GIL, CRISTINA LINARES, PATRICIA MUÑOZ, EDUARDO OLIER, PAULINO PASTOR, MARÍA LUISA PEDRO-BOTET, XAVIER QUEROL, JAVIER TOVAR, ISABEL URRUTIA, FELIPE VILLAR, ESTEBAN PALOMO

Published: 11 March 2022

http://www.doi.org/10.37201/req/171.2021

Ambient air quality, pollution and its implication on health is a topic of enormous importance that is normally dealt with by major specialists in their particular areas of interest. In general, it is not discussed from multidisciplinary approaches or with a language that can reach everyone. For this reason, the Health Sciences Foundation, from its prevention area, has formulated a series of questions to people with very varied competences in the area of ambient air quality in order to obtain a global panorama of the problem and its elements of measurement and control. The answers have been produced by specialists in each subject and have been subjected to a general discussion that has allowed conclusions to be reached on each point. The subject was divided into three main blocks: external ambient air, internal ambient air, mainly in the workplace, and hospital ambient air and the consequences of its poor control. Along with the definitions of each area and the indicators of good and bad quality, some necessary solutions have been pointed out. We have tried to know the current legislation on this problem and the competences of the different administrations on it. Despite its enormous importance, ambient air  uality and health is not usually a topic of frequent presence in the general media and we have asked about the causes of this. Finally, the paper addresses a series of reflections from the perspective of ethics and very particularly in the light of the events that the present pandemic raises. This work aims to provide objective data and opinions that will enable non-specialists in the field to gain a better understanding of this worrying reality.

Rev Esp Quimioter 2022; 35(4):307-332 [Full-text PDF]


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Rev Esp Quimioter 2022; 35(3): 260-264

Retrospective observational study of the persistence of SARS-CoV-2 infection in patients previously treated with rituximab

MARÍA TERESA GÓMEZ LLUCH, BEATRIZ PROY VEGA, MARTÍN CABERO BECERRA, ÁLVARO RODRÍGUEZ, ALBERTO ESCALERA ZALVIDE, SIMÓN ÁNGEL SÁNCHEZ

Published: 10 March 2022

http://www.doi.org/10.37201/req/122.2022

Introduction. Rituximab-induced immunosuppression could be a risk factor for mortality from COVID-19. The aim of the study was to describe the prevalence of SARS-CoV-2 infection in patients who have received rituximab and its association with a persistent viral infection
Material and methods. Retrospective observational study of patients who received rituximab in the 6 months before to the onset of the pandemic. We analyzed the presence of infection and associated them with demographic variables, pathological history related to an increased risk of developing severe COVID-19, the doses of rituximab received, the type of ventilatory support, thromboembolic events, and the treatment received. A descriptive analysis of all the variables was carried out and infected and uninfected patients were compared.
Results. We screened a total of 68 patients who had received rituximab (median cumulative dose: 4,161mg (2,611–8,187.5)). 54.4% men, mean age 60.8 years (15.7; 25-87)). C + was confirmed for 22 patients. Of these, 45.5% had high blood pressure, 36.4% Diabetes Mellitus, 31.8% smokers/ex-smoker, 22.7% lung disease, 13.6% heart disease and 4.5% obesity. There were no statistically significant differences between C+ and C-. Only 2 patients developed immunity. For 10 patients (45.5%) did not have a negative CRP until the end of the follow-up. There was no association with cumulative dose of rituximab. The mortality rate was 22.7% in the C+.
Conclusions. We observe that the persistence of the infection leads to a worse evolution of COVID-19. The use of alternatives should be considered during the pandemic, because of patients with decreased B-cell function may have high risk of fatal progression from COVID-19.

Rev Esp Quimioter 2022; 35(3): 260-264 [Texto completo PDF]


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Rev Esp Quimioter 2022; 35(3): 299-300

Neumonía secundaria por Bordetella hinzii en paciente con infección por SARS-CoV-2  

MARÍA NIEVES CARMONA TELLO, TOMÁS TOSCO NÚÑEZ, IRENE JOSEFINA SAINZ DE AJA CURBELO, FERNANDO CAÑAS HERNÁNDEZ

Published: 7 March 2022

LETTER TO THE EDITOR

http://www.doi.org/10.37201/req/160.2021

Rev Esp Quimioter 2022; 35(3): 299-300 [Texto completo PDF]


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Rev Esp Quimioter 2022; 35(3): 293-294

Neisseria meningitidis bacteraemia and SARS-CoV-2 infection: a coinfection that reminds previous epidemic outbreaks  

MIGUEL MARTÍN-ROMERO, DAVID CLAVERO-MARTÍNEZ, ANTONIA MARÍA CASTILLO-NAVARRO, ELISA GARCÍA-VÁZQUEZ

Published: 4 March 2022

LETTER TO THE EDITOR

http://www.doi.org/10.37201/req/151.2021

Rev Esp Quimioter 2022; 35(3): 293-294 [Full-text PDF]


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